Emergency Care and Coverage

Emergency care is the service or treatment provided in the outpatient emergency department of a hospital or other facility within 72 hours of the onset of the emergency medical condition.  

An emergency medical condition is a medical condition that manifests itself by such acute symptoms of sufficient severity, including severe pain, that a prudent layperson with average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in any of the following:

• Placing the health of an individual, or with respect to a pregnant woman, the health of the woman or her unborn child in serious jeopardy;
• Serious impairment of bodily functions; or
• Serious dysfunction of a body organ or part.

Emergency care provided in an emergency room is always covered under your plan, even if the emergency department or ambulance provider is out of network. Emergency services, including air ambulance services and ground ambulance services in Ohio, are not subject to balance billing.

If you need additional care after emergency treatment, such as hospital admission or transfer for continued treatment, your ongoing care must take place at an in‑network hospital to receive the in‑network benefit level, when it is medically safe to do so. Receiving continued care at an in‑network facility helps avoid unexpected costs and ensures your care is coordinated with contracted hospitals and providers.

If your care cannot be safely transitioned to an in‑network hospital, such as for postoperative care during the surgical global period, please contact OSU Health Plan (OSUHP) for assistance with care coordination and benefit guidance.

To find in‑network hospitals or for help with emergency admissions or transition‑of‑care questions, call 614‑292‑4700.