After-Hours Care
Using Private Health Insurance

Supplemental Insurance Checklist

	IF YOU HAVE A MEDICAL EMERGENCY, CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM REGARDLESS OF INSURANCE CONSIDERATIONS.
	CARRY YOUR HEALTH INSURANCE CARD AT ALL TIMES.
	If you have HMO coverage, call for pre-approval of all non-emergency services.
	If you have PPO coverage, find the appropriate provider from your provider list for this area.
	If you have indemnity insurance, contact the provider of your choice.
	Keep all receipts for services, doctor's costs, pharmacy items, and medical equipment. It may be necessary to submit these to your insurance company at a later date.
	Know which pharmacies accept your health plan. If there is no pharmacy in this area (as is the case with Kaiser), check to see if the Health Services' Pharmacy has the medication. Our prescription prices are generally the best in town.

When should you seek after-hours care instead
of waiting for the Health Center to open?

As a general rule, you should seek care after regular Health Center hours in case of a medical emergency or when your medical condition appears to need attention immediately. If your medical condition is worsening quickly or if you are unable to do key activities to provide for yourself, then you should seek care from a community provider.

What is a Medical Emergency?

A medical emergency is a medical condition that is an immediate threat to your life or long-term health. Conditions such as an open chest wound, spinal injury with a loss of sensation, serious difficulties in breathing, an obvious fracture, unconsciousness (e.g. drug or alcohol overdose), or suicidality constitute medical emergencies. Generally, if your medical condition can wait until the next day for assessment or treatment, it is not a medical emergency. If you or someone you know is experiencing a medical emergency, call 911 or go immediately to the nearest emergency room. The following are the 24-hour emergency rooms in San Luis Obispo.

Sierra Vista Regional Medical Center 1010 Murray Street 805-546-7600

French Hospital Medical Center 1911 Johnson Avenue 805-543-5353

All types of insurance cover the treatment of medical emergencies in this community. However, some insurers, particularly health maintenance organizations (HMOs), will not pay for non-emergency care provided in an emergency room.

When is Urgent Care needed?

If your medical condition is worsening or is serious enough to interfere with your ability to perform your needed activities, then you may want to use an Urgent Care facility. Common problems would include high fever that does not respond to Tylenol, ongoing vomiting or diarrhea, moderate athletic injuries. For non-emergency after-hours care, urgent care facilities can be substantially less expensive to use than an emergency room. If you have an HMO, be sure to call for pre-approval. If you have a Preferred Provider Organization plan, check to see which facility is on your list of preferred providers.

Family & Industrial Medical Center-Urgent Care 47 Santa Rosa 805-542-9596

Med Stop 283 Madonna Road 805-549-8880

How to Know What Kind of Insurance
You Have (and How it Works)

Health Maintenance Organizations (HMOs)

If your insurance requires a per visit co-pay, then you probably are covered by an HMO. An important consideration for HMO customers is that any medical service other than care from your primary care provider or emergency medical services will require pre-approval by your HMO. Without pre-approval, most claims will be refused payment and you will be stuck paying the entire bill. Your membership card will have the number you need to call for pre-approval. In general, your care under an HMO is managed by a Primary Care Provider. If you plan on living in San Luis Obispo County for the Academic Year or longer, you may want to consider changing to a primary care provider in this County, since his/her approval will be needed for specialty care referrals. This will save you from having to drive home for that approval. This will not affect your ability to use the Health Services' providers for your routine health needs.

Kaiser (Out-of-County HMOs)

Kaiser Permanente is the largest insurer of Cal Poly students, but does not operate in San Luis Obispo County. If your HMO does not operate in this County, you will be covered only for emergency care in this County. If you are unsure if your condition is an emergency, call your HMO for pre-approval. We are available for problem solving if you are having difficulties with your out-of-county HMO. Just come in or call Insurance and Billing Services at 805-756-5265

Indemnity Insurance Plans

Indemnity insurance plans simply pay a percentage of your medical expenses after your deductible is met. In most instances, you will not have to submit bills for medical care, but you will probably have to submit bills for pharmacy items and medical supplies in order to be reimbursed. If you have a $500 deductible plan, the insurance will not pay for the first $500 of expenses you incur.

Preferred Provider Organizations (PPOs)

Preferred Provider Organizations work very similar to indemnity Insurance, except that PPOs create groups of providers that you can see at a discount. For example, they may pay 80% of your bill if you see someone from their provider list, but only 60% if you see someone who is not on the list. Frequently there is a deductible. If you have a $500 deductible plan, the insurance will not pay for the first $500 of expenses you Incur.

Inpatient Hospital Care

Hospital care is extremely expensive. If you are going into the hospital, it is critical that you follow the correct procedures set by your insurance company. If you are covered by an HMO, your hospital stay must be pre-approved by the HMO or you stand a high probability that they will not pay for your care. The hospital admitting office should help with pre-authorization, but in order for them to do that effectively they need your Insurance card.

(BE SURE TO CARRY IT WITH YOU AT ALL TIMES.)

When You Need to Use Private Insurance

1. For emergency services.
2. For hospitalization.
3. For urgent services that occur after Health Services' hours (see inside ~ brochure for urgent care facilities in San Luis Obispo).
4. For the services of medical specialist not available at the Health Services.
5. For basic health services away from campus (note that you can receive basic health services from any Cal State University campus if you are currently enrolled CSU student).

• Supplemental Insurance is available at Health Services. Applications are available at the Front Desk.
• If you have trouble using your insurance or have payment for services denied, we're here to help. Stop in or call us for advice.