Emergent and Urgent Care

Emergent Care

In the event of a medical emergency, emergency room care is covered wherever it is received. It may be necessary to call 911 for immediate medical care for your emergency. Please contact your primary care practitioner (PCP) as soon as possible to arrange for follow-up care, if needed.

If you are seen in the emergency room and then admitted to the hospital, you must notify us within 48 hours of being medically able. Please call us at 866.631.5404.

An emergency medical condition manifests itself by acute symptoms of sufficient severity, including severe pain, to lead a prudent layperson who possesses an average knowledge of health and medicine to reasonably conclude that a lack of immediate medical attention will likely result in any of the following:

  • Serious jeopardy to the person’s health, or with respect to a pregnant woman, serious jeopardy to the health of the woman or her unborn child
  • Serious impairment to the person’s bodily functions
  • Serious dysfunction of one or more of the person’s body organs or parts

Examples of emergency medical conditions include, but are not limited to, loss of consciousness, severe burns, severe pain, heavy bleeding, and possible heart attack. For emergency medical conditions that occur in our service area, we encourage you to access the closest in-network emergency facility. When out of our service area, access the closest hospital emergency facility. Please arrange follow-up care through your PCP.

Covered expenses for emergency care received from a non-participating provider are limited to the Non-participating provider reimbursement.

Please contact your PCP prior to receiving non-emergency care, which may be rendered in an emergency or urgent care setting.

If your situation is an emergency and you need a prior authorization for medication, please call 866.631.5404 and let us know of your emergency. Aspirus Health Plan will follow federal law time requirements in responding to expedited requests.

Out-of-Area Care

If you are out of our service area and a medical emergency requires you to go to an emergency room, you are eligible for coverage regardless of which emergency room you use. If you are admitted to the hospital, you must notify us within 48 hours of being medically able at 866.631.5404.

If additional medical services are needed for care that is not a medical emergency, or for follow-up care, you will need an approved prior authorization from Aspirus Health Plan prior to receiving services. You may need to return to the service area to receive treatment from a participating provider.

Some out-of-area medical facilities that are not in-network may require you to pay for your care at the time it is given. To arrange for reimbursement, please send itemized bills and proof of payment within 90 days to the Aspirus Health Plan claims address below. You are responsible for all out-of-network charges that exceed the Non-participating provider reimbursement. Routine care is eligible for coverage only when received from a participating provider.

Claims Address:
Aspirus Health Plan
PO Box 1062
Minneapolis, MN 55440

Urgent Care

Urgent Care means health care for an illness or injury with symptoms of sudden/recent onset that require medical care the same day. Examples of urgent care situations include, but are not limited to, sprained ankle, minor cut, minor burn, and children with fever.

During business hours, services for urgent care situations will be provided in your PCP’s office whenever possible. For after-hour services, please contact your PCP directly.