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Urgent & Emergency Care

Emergency care saves lives. It's also some of the costliest medical care provided, which is why it's important to know the distinction between the need for emergency care, urgent care and a visit to your primary care physician (PCP). Knowing in advance how to respond to a true emergency situation can help you avoid unnecessary out-of-pocket expenses-and, most importantly, ensure the most appropriate care in the most appropriate setting.

When It's an Emergency

It's our goal at Santa Barbara Select IPA to provide our patients with quality medical care. It is also our desire to educate our patients about the best course of action to take in a medical situation. An emergency is defined as a severe and sudden medical condition (or injury, active labor or severe pain) that requires immediate medical care to avoid any of the following:

1.) Putting the patient's health in serious jeopardy
2.) Serious impairment to bodily functions
3.) Serious dysfunction or disfigurement of a bodily organ or body part
4.) For a pregnant woman, serious jeopardy to the health of the baby

The above definition is based on an average person's (not a trained medical professional's) reasonable belief that his or her condition, sickness or injury could result in the above outcome if not treated immediately. Following are some examples of true emergencies requiring immediate medical attention (other severe conditions may also be considered true emergencies):

• Breathing problems or choking

• Severe chest pain

• Convulsions

• Sudden blackouts or being unable to move or speak

• Loss of consciousness

• Deep cuts or uncontrolled bleeding

• Severe burns

• Severe head injury

• Convulsions

• Poisoning

• A broken bone or sudden severe pain and swelling in a joint

• Injuries from an attack by a person or animal

• Feelings of wanting to hurt yourself or commit suicide

• Fever over 102 degrees

When these situations arise, you may, if time permits, attempt to contact your primary care physician to prescribe authorize and/or direct your health care. However, if you face an emergency, do not hesitate to go to the nearest emergency room for treatment or call 911. Then contact your primary care physician within 24-48 hours or as soon as possible afterward.

If you do have to visit an emergency room, the circumstances surrounding your visit will be carefully reviewed by our medical staff to determine if emergency criteria was met. If after medical review the documentation received does not indicate an emergent situation, you may be responsible for payment of the incurred charges.

When It's Urgent

Sometimes situations occur that you feel require prompt medical attention (within 24 hours) but are not as serious as an "emergency." In these "urgent" situations, you should first call your primary care physician to arrange, advise and/or authorize the necessary medical care. If for some reason it is on a weekend, holiday or outside of normal business hours, your primary care physician or an on-call can be reached by dialing your physician's regular office number, 24 hours a day, 7 days a week. If the physician you reach cannot see you soon enough, he/she will advise you to go to one of Santa Barbara Select IPA's Urgent Care Centers. If you are having a complication related to recent specialist care, such as a recent surgery or hospitalization, you should call the specialist/surgeon who most recently treated the condition. Some examples of urgent situations that are best treated in your doctor's office include (but are not limited to):

• Colds

• Flu

• Nausea or vomiting

• Minor lacerations or burns

• Ear infections

• Minor sprains

• Fever under 102 degrees

It can, at times, be difficult to determine how serious your condition is. That's why, whenever possible, you should call your primary care physician for medical advice. Remember, your primary care physician is responsible for prescribing, authorizing and directing your health care.

If you have further questions about emergency and urgent care (and are not presently experiencing a possibly emergency or urgent situation), you may call our Member Relations Department at (805) 278-6823 or the Telephonic Device for the Hearing Impaired (TDHI) at (888) 877-5378 during regular business hours. Your cooperation in learning how to handle emergent and urgent situations helps us to better assist you.