Office Visit vs. an ER Visit

Kentucky Spirit Health Plan understands that you may have health conditions that need immediate attention. Many times the condition may require a visit to an emergency room (ER). How do you determine if or when you or a loved one should go to the ER?

If you think that you or a family member is having a medical emergency, go to the ER to see a doctor right away. You may need to call 9-1-1 if the person’s condition needs immediate attention where you are. For non-emergencies, please contact your primary care provider (PCP). Or speak with an on-call staff member. You may also call NurseWise - our nurse advise line – for assistance. The NurseWise number is (866) 643-3153.

Medical conditions that generally do not require an ER visit*:

• Earaches.
• Minor cuts in which bleeding has been stopped.
• A bite from an animal that has stopped bleeding (you should still call your doctor).
• Broken bone (first contact your doctor, if possible; otherwise go to the ER).
• A rash, sunburn or minor burn.
• Sting or bite from an insect (unless you experience labored breathing, in that case go to the ER or call 9-1-1 immediately).
• Fever (if you are convulsing, then go to the ER).
• Sexually-transmitted diseases (STDs).
• Adult colds, kid colds and cough, sore throat, or flu symptoms.

Routine medical visits may include:

• Child immunizations.
• Child wellness check-ups (HealthChecks).
• Important health maintenance visits (including mammograms, pap and pelvic exam and prostate exam).
• Follow-up visits for chronic problems such as diabetes and high blood pressure.
• Prenatal (pregnancy) visits.
• Smoking cessation (quit smoking counseling or medication).
• Difficulty breathing, shortness of breath.
• Chest or upper abdominal pain or pressure.
• Fainting, sudden dizziness, weakness.
• Changes in vision.
• Confusion or changes in mental status.
• Any sudden or severe pain.
• Uncontrolled bleeding.
• Severe or persistent vomiting or diarrhea.
• Coughing or vomiting blood.
• Suicidal feelings.
• Difficulty speaking.
• Unusual abdominal pain.

Kentucky Spirit Health Plan supports each member and family member in their decision for medical care. Always get immediate medical attention if you think you or a loved one is having a medical emergency. You may need to call 9-1-1 if the person’s condition needs immediate attention where you are.