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You never know what might come up when you are away from home, so be prepared. Here you will find information to help you plan for a healthy trip and get medical care if you need it. Here are some common examples, which don’t include all possible symptoms and conditions.

Emergency Care

Emergency care is for a medical or psychiatric condition, including severe pain, that requires immediate medical attention to prevent serious jeopardy to your health.

Examples include:

  • Chest pain or pressure
  • Severe stomach pain that comes on suddenly
  • Severe shortness of breath
  • Decrease in or loss of consciousness

If you reasonably believe you have an emergency medical condition, call 911 or go to the nearest emergency department. An emergency medical condition is a medical or psychiatric condition that requires immediate medical attention to prevent serious jeopardy to your health. For the complete definition of an emergency medical condition, please refer to your plan documents.

                Medicare Advantage (Evidence of Coverage)

                State of Oklahoma Group Retirees (Evidence of Coverage)

                Federal Employees Health Benefits (Brochure)

                State, Education, and Local Government (Member Handbook)

                Commercial Group (Member Handbook)

Urgent Care

Urgent care is for a condition that requires prompt medical attention, usually within 24 or 48 hours, but is not an emergency medical condition.

Examples include:

  • Minor injuries and cuts
  • Backaches and earaches
  • Upper-respiratory symptoms
  • Sore throats
  • Frequent or severe coughs
  • Frequent urination or a burning sensation when urinating

Routine Care

Routine care is for an expected care need, like a scheduled visit to your doctor or a recommended preventive screening.

Examples include:

  • Physical exams
  • Adult and well-child checkups
  • Pap tests
  • Follow-up visits

Routine services aren’t covered outside the GlobalHealth service area,
so make sure to get them before your trip.

How do I get out-of-network emergency care?

If you or a family member has a medical emergency, get care right away. You don’t have to let us know or get approval first. Here’s what to do:

  • Call 911 or go to the nearest hospital. Always use the emergency services available where you are.
  • Once your condition is stable, call Customer Care to let us know you’ve received emergency care or been admitted to a hospital. If appropriate, the doctor treating you can call instead.
  • When you call us, we’ll talk to the doctor treating you to discuss your condition, health plan coverage information, and help decide what to do next.

What if I still need care after my emergency condition has been stabilized?

If you have been hospitalized, the doctor treating you may decide you still need care after your condition has been stabilized. This is called post-stabilization care. You will need to get approval from us for this kind of care to be covered under your plan.

Call us as soon as you can, preferably before you get care. Getting approval helps protect you from financial responsibility, since we may not cover services we don’t approve first.

If we agree you need post-stabilization care, we may authorize the doctor treating you to give you this care. Or we may choose a different provider who can provide the right care for your condition.

Ask the doctor treating you if we have approved your care, including any transportation. In addition to post-stabilization care, you will need to get any related transportation approved. When medically necessary transportation is needed for your care (as determined by GlobalHealth), we will arrange these services for you.

Post-stabilization follow-up care is generally not covered, unless we authorize it or it is considered urgent. This includes any follow-up care you need after an emergency or urgent care visit, like removing stitches or a cast. Call us before you get follow-up care to check whether it is covered.

How do I report emergency care?

Call to let us know you’ve been admitted to a hospital with an emergency condition, or to ask for approval for post-stabilization care.

How do I get out-of-network urgent care?

If you need urgent care while outside our service area, you can visit an urgent care facility instead of a hospital emergency department. We will cover medically necessary urgent care as long as it can’t wait until you get back home.

How do I submit a claim?

If you paid for emergency or urgent care while away from home, you will need to file a claim for reimbursement. The following information is required for all claims:

  • Itemized bills (should include date of service, services received, and cost of each item)
  • Medical records (copies of original medical reports, admission notes, emergency room records, and/or consultation reports)
  • Proof of payment (receipts or bank or credit card statements)
  • For help with filing a claim for reimbursement, contact Customer Care.

Still have questions?

For a complete description of your coverage, you should read your plan material. Contact Customer Care to request a copy of your plan materials.

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