Choosing the Right Care

When making decisions about the medical attention you need, use your best judgment and take advantage of available health and wellness resources.

Talk to Your Doctor
Calling your primary care physician to describe your symptoms is always a good first step. Many doctors can rearrange their schedules to squeeze patients in for needs which are not emergencies, but need medical attention.

Research Your Symptoms
The Healthwise^® Knowledgebase is a useful tool to help you make decisions. This resource contains more than 3,200 topics on health conditions, medical tests, procedures, medications, and everyday health and wellness issues.

Urgent Care

Most health situations do not require emergency medical care. In fact, you can save time and often save money by using one of the many urgent care clinics available to you through your health plan. Examples of conditions for which a visit to urgent care may be appropriate include:

• Coughs and congestion
• Diarrhea
• Ear infections
• Insect bites
• Lacerations (deep cuts or wounds that may require stitches)
• Mild to moderate asthma attacks
• Rashes
• Sprains, strains, or deep bruises
• Sore throats
• Upper respiratory infections
• Urinary tract infections

Use the Find a Doctor tool, to locate an in-network urgent care facility near you.

Emergency Room Care

If you have a true medical emergency, you should go to the nearest hospital as fast as possible whether in or out of the service area. It's important for you to know what kind of medical problems are defined as emergencies and how to arrange for ambulance service, if needed. Contact WPS within two business days after emergency admission to a hospital.

Consult your benefit plan for answers to the following questions:

• How does your plan define "emergency care?" What conditions or injuries are considered emergencies?
• How does your plan handle "urgent care" after normal business hours? Urgent care is for problems that are not true emergencies, but still need quick medical attention. Check with your plan to find out what it considers to be urgent care. Examples may include sore throats with fever, ear infections, and serious sprains. Call your primary care doctor or your plan's hotline for advice about what to do. The plan may also have urgent care centers for members.
• How do I obtain urgent care or emergency care if I am out of my network coverage area?
• How and when should I inform my plan administrator after I receive care?

Urgent Care or Emergency Room?

Helpful Forms

• Inpatient Pre-Certification Guidelines
• Outpatient Pre-Authorization Guidelines
• Medical Preauthorization Request Form
• Drug Preauthorization List