An emergency condition is when you are experiencing extreme or sudden pain or have acute symptoms that require immediate medical diagnosis, care and treatment to avoid disability or death.

Emergency services are those required for an acute medical condition in which a prudent layperson could reasonably expect the absence of immediate medical attention to result in serious jeopardy or harm.

If you have an emergency situation, call 911 or go to the nearest emergency room no matter where you are located. You do not need pre-approval from your physician for initial ER care, but related follow-up care should be provided through your primary care physician.

Urgent care means services that are medically required within a short time frame, usually within 24 hours, in order to prevent serious deterioration of a member's health due to an unforeseen illness or injury.

If an urgent care situation arises while you are in WHA's service area, call your PCP. You can call your doctor at any time of the day, including evenings and weekends. Your doctor or the physician on-call will direct your care. To make sure urgent care services are covered while you are in the service area, go only to your medical groups' contracted urgent care clinic. When you are outside the service area, contact your PCP first for direction. View the Provider Directory for local urgent care clinic locations. For more information, visit mywha.org/er.

To keep your care coordinated, it’s always best to try and reach your doctor first if you need urgent care. You have the option of Teladoc described above or can visit a network urgent care center. If you are in the WHA service area, be sure to go to a facility affiliated with your PCP’s medical group. You can use WHA's online Provider Directory to find an urgent care facility that is affiliated with your PCP's medical group.

If you are outside WHA’s service area and hospitalized because of an emergency, WHA covers those services. However, you must notify WHA within twenty-four (24) hours or as soon as possible to avoid any billing issues. If you are unable to make the call, have someone else make it for you, such as a family member, friend or hospital staff member. 

Follow-up care after an emergency room visit is not considered an “emergency” situation. If you receive emergency treatment from an emergency room physician or non-participating provider and then return for follow-up care, you are responsible for the cost of the service. 

To learn more, click on this convenient care flyer to see how to access all of your care options.

WHA has care options for when you need it most—in and out of the WHA service area. If an urgent care situation arises, call your PCP—any time of the day, including evenings and weekends. Your doctor or an on-call doctor may provide you with home care remedies, offer a virtual visit or, if necessary, direct you to seek care at the emergency room or your medical group’s contracted urgent care center. Your doctor's phone number is easily available when logged in to MyWHA or WHA's mobile app. 

For mental health concerns, contact Optum Behavioral Health at 800.765.6820 for help in coping with feelings of fear, sadness, anger and , hopelessness. 

There are times when you can’t get to your doctor’s office or urgent care location.

Nurse Advice (24-hour) 888-656-3574. When you need medical advice about a health issue, members may talk to a nurse at any time day or night (at no cost). Through WHA's confidential nurse advice line, talk with a registered nurse who can evaluate symptoms, offer advice, assess care and treatment options, and assist in determining whether to seek urgent or emergency care from a nearby network facility. For more information, visit mywha.org/nurseadvice. 

In non-emergency situations, members may also use Teladoc to reach a doctor 24/7 by secure video chat or phone, to get a diagnosis and treatment. Teladoc lets you connect with an urgent care healthcare professional for minor injuries and illnesses such as cold or flu, minor cuts or burns, muscle strains or sprains, upset stomach or skin rashes. Get help using Teladoc's virtual access or call 1.800.Teladoc (800.835.2362). 

Visit our virtual care page for details on all telehealth options.