Urgent and Emergency Care

AmeriHealth Caritas New Hampshire members who require emergency care should be advised to call 911.

We help ensure emergency services and care are available 24 hours a day, seven days a week. We are responsible for coverage and payment of emergency and post-stabilization care services, regardless of whether the provider who furnishes the services has a contract with AmeriHealth Caritas New Hampshire.

Definitions and requirements regarding urgent and emergency care are as follows:

Urgent, symptomatic office visits

Urgent, symptomatic office visits are office visits to the member’s primary care provider (PCP) or another provider within 48 hours for the presentation of medical signs or symptoms that require immediate attention but are not life threatening. These visits do not meet the definition of emergency services.

Emergency medical conditions

An emergency medical condition is a physical or behavioral condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

• Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy.
• Serious impairment to bodily functions.
• Serious dysfunction of any bodily organ or part.

Emergency services

Emergency services are covered inpatient and outpatient services that are:

• Furnished by a provider who is qualified to furnish these services.
• Needed to evaluate or stabilize an emergency medical condition.

Emergency services are those medical services rendered under unforeseen conditions which require hospitalization for the treatment of accidental injury and relief of acute pain, which, if not immediately diagnosed and treated, would result in risk of permanent danger to the patient's health.