After-Hours Care & Emergency Care

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For guidance and answers to your health insurance questions, talk with one of our experts by calling 1-888-322-2115, Monday - Friday, 8 a.m. - 5 p.m. (CT) or email us.

What to Do When You Need Urgent Medical Care

If you or a loved one needs immediate medical attention, don't hesitate to receive the care you need. Simply follow these steps:

  • Present your Avera Health Plans member ID card to the physician or hospital caring for you
  • Identify yourself as an Avera Health Plans member
  • Follow the instructions for billing and notifying Avera Health Plans that are located on the back of your member ID card
  • When it's medically appropriate, arrangements may be made for you to be transferred to the care of an Avera Health Plans participating provider in order for you to receive benefits at the lowest costs using in-network services

It's important to note that you may be required to pay for medical services at the time they are provided, but any covered services will be reimbursed.

Learn more about the variety of after-hours, urgent and emergency options you have as an Avera Health Plans member and when to go to the emergency room.

Preauthorization for Urgent Situations

If your situation is urgent - meaning that a delay could jeopardize your life, health or ability to regain maximum function or would cause severe pain that could not be adequately managed without the requested care or treatment - your provider will contact us so we can begin the preauthorization process. Our medical management staff will review your case and provide a decision to you and your provider within 24 hours.

In the case that they're unavailable - such as on weekends, holidays or after business hours - we do allow post-service authorization. Your provider must contact us no later than two business days after you receive the services, supplies or procedures.

Emergency Coverage with Medicare Supplement Insurance

If you have Medicare Supplement Insurance through Avera Health Plans, benefits will be paid at any Medicare-approved hospital or physician in an emergency.

If you're traveling outside of the service area at the time of your emergency, benefits will be paid at any Medicare-approved hospital or clinic for up to 90 days.

In the circumstances that the treatment you need isn't available from an in-network hospital, your provider will need to complete and fax the preauthorization form with your relevant medical records. If you have additional questions call, 1-888-322-2115 or send us an email.

Your Options for After-Hours, Urgent & Emergency Care

It's important to know your options because there's a big difference between the cost of an emergency room visit or urgent care appointment versus a free phone call.

As an Avera Health Plans member, you have access to a variety of care options. Learn more so that you can make the best decision for your family's health while saving money.

Free Nurse Line 24/7

Our qualified, trained staff and registered nurses are available to answer your medical questions via the 24/7 nurse line. They'll also help you judge the severity of your situation and direct you to a nearby facility, if needed. Call 605-322-1354.

Minor

Minor InjuriesAveraNow app - *FREE
Use our 24/7 provider video visits to get fast and convenient treatment for: UTI, flu, diarrhea, allergies, rashes, pink eye, etc. It's always free and unlimited with your special coupon code, found on the back for your member ID card. Can be used anywhere in the U.S. Patients must be at least 2 years old.

2018 Avera Health Plans Member Card Back View

*AveraNow qualifies for medical reimbursement as an allowable expense, so you can use your Flexible Spending Account for payment. Check with IRS regulations or your flex benefits administrator every year as eligible items and services can change. If you have a high deductible, HSA-eligible plan, consult your tax adviser on the use of AveraNow for possible tax implications.

Urgent Care

Urgent Care Injuries

Questions to ask yourself based on your situation.

  1. Is it after office hours?
  2. Are you traveling?
  3. Can it wait until the morning?
It Can Wait

Primary Doctor - $
Your primary care doctor knows you best and the clinic is equipped to handle all minor and serious issues. They'll handle care during regular business hours for sickness, injury and preventive services.

Make sure they're in-network or you'll pay more!

I Need Care

Urgent Care - $$
Urgent care is a great option for evening and weekend care but it is not open 24 hours.

They'll handle issues that require immediate attention: minor cuts and burns, sprains and broken bones, respiratory issues.

Emergency

Emergency Injuries

Go to the nearest ER! - $$$
This is the most expensive option; use for critical issues such as chest pain, head injuries, trouble breathing, fevers over 103 degrees in babies 3 months and older.

Details about your out-of-pocket costs for an ER visit are outlined on page 3 in your Summary of Benefits and Coverage located on our member portal. Log in to learn more.