Your Doctor, Urgent Care, Or the Emergency Room?

When you or a loved one is sick or injured, you may be unsure where to go for care. The facility best equipped to care for your medical situation depends on the severity of your condition.

In Non-Emergency Situations NOT Requiring Immediate Care

In these cases, your primary care provider (PCP) or health care provider can diagnose and treat illnesses and injuries, and answer any general questions you have about your health. Seeing your PCP or health care provider usually requires making an appointment in advance.

PCPs and health care providers typically see patients Monday through Friday during regular business hours. Outside of regular business hours, you can call your PCP or health care provider and the on-call physician will help you.

In Non-Emergency Situations Requiring Immediate Care

Urgent care centers provide medical care for non-life threatening illnesses and injuries that require immediate care (treatment within 24 hours). Urgent care centers typically see patients on a walk-in basis, meaning you do not need to make an appointment.

They are open during and after regular business hours, on weekends, and during holidays, but not usually overnight.
Here are some conditions that urgent care centers are equipped to treat:

• Sprains and strains
• Fevers
• Sinus infections
• Ear infections
• Non-life threatening allergic reactions
• Minor cuts and burns
• Rashes
• Non-severe headaches
• Urinary tract infections (UTIs)

If you require urgent care, start by calling your PCP or health care provider. If you are unable to see your PCP or health care provider, you are covered for urgent care provided by another doctor in or outside of our network (you do not need a referral for urgent care). Many practices have a built-in urgent care capacity or affiliated urgent care clinic that has access to your medical records.

Typically, urgent care visits cost less than emergency room visits, and you can usually be seen more quickly.

In Emergency Situations

If you believe your health is in serious danger, call 911 or go to your nearest emergency room. Emergency rooms treat serious illness and injuries, including:

• Heart attack/chest pain
• Trouble breathing
• Stroke or sudden paralysis
• Loss of consciousness
• Uncontrolled bleeding
• Broken bones
• Large wounds
• Head injuries
• Severe burns
• Poisoning
• Seizures
• Mental health emergencies
• Car accident injuries

You do not need to get approval or a referral from your PCP or health care provider if you have a medical emergency. You are covered anywhere in the world for emergency or urgent care.

How Your Plan Helps

You are covered anywhere in the world for emergency or urgent care
Tufts Health Plan Medicare Advantage HMO and PPO plan members can be outside our service area for up to six consecutive months and still be covered for emergency or urgent care. Our service area is the state of Massachusetts except for Berkshire, Franklin, Dukes, and Nantucket Counties. Our plan cannot cover a prescription drug purchased outside of the United States and its territories.

If you receive emergency or urgent care outside our service area, you may need to pay out of pocket. Simply save your receipts and call Member Services for reimbursement details.*

*Reimbursement applies to emergency and urgent care situations only. You may be responsible for any copays that apply.