Terms and Meanings
Some terms that we use in this chapter may not be familiar. These terms and their meanings are listed below.
- Alignment: To straighten the spine.
- Approved/Authorized: The decision Medicaid makes to pay for a service.
- Assistance: Help.
- Facility: A health care building or practice.
- Individuals: People.
- Laboratory tests: Medical tests done on bodily fluids like blood or urine to find a health condition or illness.
- Primary Care Provider: Your main health care professional who maintains your good health and cares for your basic health needs by giving vaccines, finding disease, and offering medication or treatment for conditions or symptoms.
- Provider: A doctor, nurse, therapist, or another qualified health care professional.
- Referral: A written order from your primary care doctor for you to see a specialist or get certain medical services.
- Services: Care, treatments, testing, checkups, equipment, supplies, and other ways your health care providers help you stay healthy.
Coverage for Emergency Services
A medical emergency is an event that could cause you harm or threaten your health. If you are pregnant, this includes the health of you and your unborn child. During an emergency, you should go to the nearest hospital or call 911. You always want to consider what level of treatment you need and the right choice for where to be treated.
Where to Go for Treatment
It is important that you know the right place to go for your health emergencies. Sometimes you may need to be cared for in an emergency room. Other concerns can be addressed in different settings, keeping our emergency rooms available for true health emergencies.
Go to an Emergency Room
Emergency rooms are meant to treat life-threatening conditions. They can offer minor procedures, surgeries, life support, diagnostic services, and more. Emergency rooms have limited space, are costly, and have long wait times. Decide whether you can be treated at an urgent care or your provider’s office before going to an emergency room. Managing your medications, treating minor illness, and addressing tolerable pain are examples of care that can be done at your provider’s office instead of an emergency room. Hospital emergency rooms care for many emergency health concerns. Services are not limited to the list below.
- Hospital emergency rooms care for:
- Large or severe burns
- Life-threatening health events
- Major broken bones
- Major accidents and falls
- Poisoning
- Serious illness that poses immediate threat to your health
- Severe cuts that involve large amounts of blood
Walk into an Urgent Care
If you are not having a life-threatening, medical emergency, but you cannot manage your pain or your condition is getting worse, you should be seen at an urgent care. Urgent care clinics (or walk-in clinics) can offer bandaging, medications, and diagnostic services, including X-rays and laboratory tests. They can be used outside of normal office hours or when your regular provider cannot offer a timely appointment. You can walk in and be seen that day, but you may wait longer in this waiting room than you would at your provider’s office.
- Urgent care or walk-in clinics can care for:
- Accidents and falls
- Cuts that don’t involve much blood but might need stitches
- Eye irritation and redness
- Fever or flu
- Minor broken bones like the small bones in the hands and feet
- Moderate back problems
- Severe sore throat or cough
- Skin rashes and infections
- Sprains and strains
- Urinary tract infections
- Vomiting, diarrhea, or dehydration
Schedule an Appointment at Your Provider's Office
If your health concern is only causing you minor pain and will not threaten your life while you wait for an appointment, you may not be having an emergency. For these situations, make an appointment with your primary care provider. You may wait several days to be seen but you will not spend as much time at your provider’s office the day of your appointment. Your provider’s office can care for:
- Minor injuries from accidents and falls
- Regular checkups, vaccines, mental health concerns, and more
- Tolerable symptoms of sickness
- Medication management
- Minor or manageable pain
- Skin rashes and infections
- Sprains and strains
- Urinary tract infections
- Vomiting, diarrhea, or dehydration
Ambulance Services
An ambulance can bring you to the emergency room and care for you during your ride. Medicaid only helps pay for this kind of ambulance service during a true medical emergency. If you use an emergency ambulance service for a non-emergency, you may need to pay for the ambulance charges. You should find other ways to get to the hospital or emergency room if you feel like you need to be seen but can safely travel without an ambulance.
Air ambulance is another form of emergency transportation that is covered. Air ambulance is an equipped aircraft with emergency health care providers and flight crew. Air ambulance is used when the member has a potentially life-threatening condition where regular ambulance travel is not sufficient or medically appropriate.
After Care
After care is the care from your provider following your medical emergency. Your emergency room providers will help you to know when you should get after care. Examples of after care are medication management, a check-up on your condition, or a referral to a specialty health care provider. Your emergency room providers will help you to know when you should get after care.
Out-of-State Emergency Coverage
Out-of-state emergency services is health care from providers or facilities more than 50 miles outside of North Dakota and within the United States. ND Medicaid will authorize emergency services after they are received. Your provider or facility will need to inform ND Medicaid of the services you received. You should be prepared to give them your ND Medicaid ID number and confirm that you are enrolled with ND Medicaid, when able. Always take your ND Medicaid card with you when you travel.
Your provider may send you to an out-of-state provider for emergency treatment if the services you need are not available within North Dakota. The provider sending you out-of-state will notify ND Medicaid and your services may be reviewed before costs are covered.
When you are being treated, give the provider or facility the information for all insurance coverage you have. Medicaid is the payor of last resort. This means that medical providers must bill all other health insurance policies a member has before billing ND Medicaid.
Using an ambulance while out of state is a covered service when the ambulance is needed in a true emergency. Air ambulance is another form of emergency transportation that is covered when regular ambulance travel is not sufficient or medically appropriate. Ambulance providers must be enrolled with ND Medicaid for their services to be covered. If the provider is not enrolled, you may be responsible for the bill.
Getting Help in an Emergency
- Call: 911
- Medical emergencies
- Fire
- Reporting a crime
- Disaster response
- Life threatening situations
- Call or Text: 988
- Thoughts of suicide
- Mental health crisis
- Substance use crisis
- Emotional distress
- Call or Text: 211
- Food assistance
- Housing and shelter assistance
- Utility assistance
- Transportation
- Other essential needs
- Go to your nearest hospital emergency room
- Serious or life-threatening medical emergencies
