After-Hours & Emergency Care | Avera Health Plans

Important Things to Know

Present your member ID card to the hospital or clinic caring for you.
Follow the instructions for billing that are located on the back of your member ID card.
When it's medically safe, we might arrange for you to be transferred to an in-network facility.
You may be required to pay for medical services at the time they are provided, but any covered services will be reimbursed.

Preauthorization for Urgent Situations

Certain care and treatment require preauthorization with us. However, if your situation is urgent – your provider may provide immediate care if needed and will contact us to begin preauthorization process.

We will review this quickly to give you and your provider a decision within 24 hours.¹

Medicare Supplement & Emergencies

In-network, your benefits are paid at any Medicare-approved hospital or physician.
If you're traveling outside the service area, benefits are paid at any Medicare-approved hospital or clinic for up to 180 days.
If your treatment isn't available from an in-network hospital, your provider needs to complete and fax the preauthorization form with your relevant medical records.
Questions? Call 888-322-2115 or send us an email.

Your Options for After-Hours, Urgent & Emergency Care

There's a big difference between the cost of an emergency room visit, an urgent care visit and a free phone call. Our members have access to a variety of care options. Here are some tips to help you make the best decision for your family's health while saving money.

Quick Care

Virtual Visits (Free)

Use our 24/7 provider virtual visits to get fast and convenient treatment for minor situations such as urinary tract infections, flu, diarrhea, allergies, rashes, pink eye and others similar conditions.

Available for free or $64 for those on a HDHP
Can be used anywhere in the US
Patients must be at least 2 years old

It Can Wait

Primary Doctor ($)

Your primary care doctor knows you best, and clinics are equipped to handle all minor and serious issues. They 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 Now

Urgent Care ($$)

If it’s after normal clinic hours and it can’t wait until morning, urgent care may be a good option. Urgent care is not open 24 hours.

Common Current Care Conditions

Acid reflux
Cold or flu
Cold sores
Diarrhea
Fever
Headache
Insect or animal bites
Minor burns, cuts or rashes
Pink eye
Seasonal allergies
Sinus infection
Sprains and strains
Stomachache
Urinary tract infections

Not Available at Urgent Care

Care for stroke, heart attack or major trauma – and anything listed under ER below
Physicals and checkups
CT scans and MRIs
Routine immunizations
Prescription refills

Critical Care

Emergency Care ($$$)

This is the most expensive option. If a life, limb or organ is at risk, always go to the ER.

When to Go to the ER

Chest pains, difficulty breathing or heart attack
Slurred speech or weakness/numbness on one side
Eye and head injuries, including potential concussions
Major trauma
Fever with a rash
Seizures
Severe cuts or broken bones
Serious burns
Fevers over 103 degrees in babies 3 months and older

ER Out-of-Pocket

Details about your out-of-pocket costs for an ER visit are outlined on page 3 in your Summary of Benefits and Coverage, located in the member portal.

Need Something Else?

See all of our member resources online.

Member Resources Member Portal

Or contact our Customer Service team.

^{1 In the case that Avera Health Plans preauthorization staff are unavailable (such as weekends, holidays or after business hours), we allow post-service authorization. Your provider must contact us no later than two business days after you receive the services, supplies or procedures.}

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