Appropriate Care Decision Guide

NC HealthSmart (Get the Care You Need)
Appropriate Care Decision Guide

Emergency Department

 

When to Use:  Hospital Emergency Departments (EDs) should be used for very serious or life-threatening conditions. If you experience any of the following symptoms, injuries, or illnesses, call 911 or visit your nearest ED:

  • Seizures or convulsions

  • Coughing up or vomiting blood

  • Sudden, severe, persistent pain

  • Childbirth

  • Severe allergic reaction

  • Severe and/or persistent vomiting or diarrhea Fever ≥ 104°F

  • Change in mental status - including any loss or alteration of consciousness, confusion, irrational thoughts, severe agitation, hallucinations, delusions, suicidal or homicidal thoughts or attempts.


[+] Posioning/Overdose

Call 911 if there is a loss of consciousness. Call the American Association of Poison Control Centers 24/7 hotline first for immediate home treatment at 800-222-1222

[+] Trouble Breathing

Including severe asthma or severe difficulty breathing with a history of chronic obstructive pulmonary disease (COPD).

[+] Signs of Symptons of a Heart Attack

  • Chest discomfort, such as uncomfortable pressure, squeezing, fullness, or pain

  • Pain or discomfort in other areas of the upper body, including one or both arms, the back, neck, jaw, or stomach

  • Shortness of breath, with or without chest pain or discomfort

  • Breaking out in a cold sweat, nausea, vomiting, or lightheadedness

  • Women are more likely to experience shortness of breath, nausea, vomiting, and back or jaw pain without chest pain or discomfort

[+] Trauma

  • Heavy bleeding that does not stop
  • Head, eye, or other major injuries
  • Burns to a large area of the body or to head
  • Major broken bones

[+] Stroke Symptoms

  • Numbness or weakness in the face, arms, or legs, especially on one side of the body
  • Confusion, trouble speaking or understanding
  • Sudden loss of vision or trouble seeing in one or both eyes
  • Trouble walking, dizziness, loss of balance or coordination
  • Severe headache with no known cause

This may vary for children, please speak with your pediatrician.


     

       2018 In-Network Emergency Department Costs

 
Plan ​In-Network Emergency Department Cost†
70/30 $337/visit; 30% coinsurance‡
80/20 ​$300/visit; 20% coinsurance‡
  †This cost is waived if you are admitted to the hospital.   ‡Coinsurance is the percentage of costs of a covered health care service you pay after you've paid your deductible.     NC HealthSmart (Get the Care You Need) Appropriate Care Decision Guide
Plan ​In-Network Emergency Department Cost† 70/30$337/visit; 30% coinsurance‡ 80/20 ​$300/visit; 20% coinsurance‡