Emergency and Urgent Situations
What to do in an Emergency
An emergency is when you have severe pain, illness or injury. It could result in danger to you or your unborn child.
- Call 911 right away if you have an emergency or go to the nearest emergency room.
- Emergency rooms are for emergencies. Call your doctor before going unless your emergency is severe.
- You can call NurseWise, our 24-hour health advice line at 1-866-796-0530 (TDD/TTY 1-800-955-8770). You will be connected to a nurse. Have your Sunshine Health Long Term Care ID card number handy. The nurse may direct you to other care or may help you over the phone.
To get emergency services, you should follow the instructions by your primary Medicaid/Medicare insurance.
Enrollees have the right to use any hospital or other setting for emergency care.
Behavioral Health Emergency
First, decide if you are having a true behavioral health emergency. Do you think that you are a danger to yourself or others? Call “911” or go the nearest emergency room for care if you think you are.
Examples of emergency mental health problems include:
- Likely danger to self or others.
- The person is not able to carry out actions of daily life
- Harm that will likely cause death or serious harm to the body
Urgent Care is needed when you have an injury or illness that must be treated within 24 hours. It is usually not life threatening, yet you cannot wait for a routine doctor’s office visit. Urgent Care is not emergency care.
When you need urgent care, follow these steps:
- Call your doctor. If it is after hours and you cannot reach your doctor, you can call NurseWise at 1-866-796-0530 (TDD/TTY 1-800-955-8770).
- You will be connected to a nurse. Have your Sunshine Health Long Term Care ID card number handy. The nurse may direct you to other care or may help you over the phone.
- You may be told to see another doctor or go to the nearest hospital emergency room.
To get Urgent Care, you should follow the instructions provided by your primary Medicaid/Medicare insurance.
How to Get Medical Care When You Are Out of the Service Region
If you are out of the area and have an emergency, go to the nearest emergency room or call 911. Show your primary Medicaid/Medicare insurance ID Card.
If you are away and have an urgent problem, go to an urgent care clinic. You may go to any primary care doctor where you are. Be sure to show your primary Medicare/Medicaid insurance ID card.
Out of Network Care
Sunshine Health Long Term Care expects you to get a referral before services are obtained. Services by out of network providers may not be paid unless prior authorization is obtained by your Case Manager.
Post Stabilization Services
Prior authorization is not needed required for emergency services or post stabilization care. This is whether you receive this care within or outside of the Sunshine Health network.