After-Hours Care & Emergency Care
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.