Wellcare CalViva Health Dual Align (HMO D-SNP): Emergency Care

Emergencies are occurrences that require immediate and complex medical attention (this benefit does not include ambulance services).

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Cost
$110 copay (waived if admitted to the hospital)
Prior Authorization Required
No, unless admitted to an out-of-network hospital
Provider Referral or Order Required
No

How To Receive

Details on how to apply

Emergency care refers to services that are:

  • Furnished by a provider qualified to furnish emergency services, and

  • Needed to evaluate or stabilize an emergency medical condition.

Contact the Member Services at 1-833-236-2366 (TTY users should call 711) for additional questions

Cost sharing for necessary emergency services furnished out-of-network is the same as for such services furnished in-network.  There is additional coverage per year for emergency care and urgently needed services when traveling outside of the United States and its territories (see Worldwide Coverage for more information).

*If you receive emergency care at an out-of-network hospital and need inpatient care after your emergency condition is stabilized, you must return to a network hospital in order for your care to continue to be covered or you must have your inpatient care at the out-of-network hospital authorized by the plan and your cost is the cost sharing you would pay at a network hospital

Availability
Ongoing

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A medical emergency is when you, your loved one, or any other prudent layperson with an average knowledge of health and medicine, believes that medical symptoms require immediate medical attention to prevent devastating illness, loss of life, loss of a limb, or loss of function of a limb.

The medical symptoms may be significant illness, injury, severe pain (including any unexplained or uncontrolled chest pain), or a medical condition that is rapidly getting worse.

Emergency care is services that are needed to evaluate, treat, and/or stabilize an emergency medical condition and are rendered by a provider qualified to furnish emergency services.

This benefit does not include ambulance services (see Ambulance Services benefit).

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