Emergency room, urgent care, primary care provider

Where you go when you get sick in the United States directly affects both your health and your wallet. If there is a life-threatening emergency, call 911 or go to the hospital emergency room (ER); for conditions that are not emergencies but cannot wait, urgent care centers are available; and for regular checkups and referrals, you choose a primary care provider. On this page, you will find where to go in different situations, your rights in the emergency room, what to consider when insured and uninsured, and your right to a free interpreter.

• 911 / emergency room (ER): an illness, injury, or symptom serious enough that a reasonable person would seek immediate treatment to avoid serious harm. In a life-threatening emergency, call 911 or go to the nearest emergency room.
• Urgent care: an illness or injury that needs to be treated promptly but is not severe enough to require an emergency room.
• Primary care provider: regular checkups, chronic disease monitoring, vaccinations, and referrals to specialists. A primary care provider may be a medical doctor (M.D. or D.O.), nurse practitioner, or physician assistant.
• Mental health crisis: call or text 988. For details, see 9.7 Mental health and Turkish-language resources.
• For other emergency numbers, see 13.1 Emergency numbers.

• Hospitals that have emergency rooms and participate in Medicare must provide a medical screening examination to everyone who comes to the emergency room, regardless of ability to pay. Labor is also covered.
• If there is an emergency medical condition, the hospital must stabilize your condition within its capabilities. If it cannot do so, or if you request it, the hospital will transfer you to another hospital under appropriate conditions.
• Four conditions are required for a transfer: the sending hospital provides treatment to reduce the risk; the receiving hospital has space and staff and accepts the patient; the records are sent; and the transfer is carried out with appropriate personnel and transportation.
• The hospital may not delay the examination or treatment to ask about your payment method or insurance.
• EMTALA guarantees access to treatment; it does not mean treatment is free. The bill comes later. For ways to get help, see 16.6 Services available regardless of status and 9.5 Billing disputes and payment plans.
• If a hospital does not follow these rules, anyone may file a complaint with the state’s oversight agency (State Survey Agency).

• Your insurance cannot require a higher copayment or coinsurance for an out-of-network hospital emergency room, and it cannot require prior authorization.
• Thanks to the No Surprises Act, in most cases you cannot be charged more than your in-network share for an emergency room visit. This protection applies to:
  • a hospital emergency room
  • independent emergency rooms not affiliated with a hospital
  • air ambulances
• After the emergency, once your condition has stabilized, an out-of-network provider may ask you to sign a “notice and consent” form for services provided during post-stabilization. Signing this form means giving up your protections. You cannot be asked to sign such a form in the emergency room.
• Ground ambulances are not covered by these federal protections; state rules may differ.
• Some plans do not cover urgent care at all. If you are unsure, call your insurance company.

• You may choose any eligible primary care provider in your plan’s network. For your child, you may choose an in-network pediatrician as the primary care provider.
• You do not need a referral from a primary care provider to see an obstetrician-gynecologist (OB-GYN).
• Some plans, such as HMOs, require a referral from a primary care provider to see other specialists.
• Preventive services, such as vaccinations and screening tests, are free in most cases when obtained from an in-network provider, even if you have not met your deductible.
• Choose your primary care provider while you are healthy, before an emergency occurs. Ask your plan’s doctor directory or customer service about in-network doctors, whether they are accepting new patients, and the languages they speak.
• If you have Medicare, see 17.6 Medicare for the annual “Wellness” visit and the first-year “Welcome to Medicare” visit.
• For children’s vaccinations and checkups, see 8.6 Children’s health.

• Community health centers: offer pregnancy care, infant vaccinations, general primary care, and referrals for mental health, substance use, and HIV/AIDS services on a sliding-fee scale based on your income. Before going, call the center and ask what documents they require (see 16.6).
• Price estimates for scheduled care: if you are uninsured or do not use your insurance, the provider generally must give you a written “Good Faith Estimate” when you schedule an appointment at least 3 business days in advance or request one. This estimate is not provided for emergency care. Details: 9.5.
• Hospital financial assistance: tax-exempt nonprofit hospitals must implement a written financial assistance policy covering all emergency and medically necessary care. When the bill arrives, ask for the application form.
• Emergency Medicaid: for people who meet the state’s income and residency requirements but do not have an eligible immigration status, Medicaid may cover treatment of an emergency medical condition (see 16.3).
• Prescription drugs: HealthCare.gov directs people without insurance to TrumpRx.gov for discounted prices on some prescription drugs. This site operates outside Marketplace coverage.

• Health programs and organizations that receive federal financial assistance must provide meaningful access to people with limited English proficiency. This includes hospitals, Medicaid and Medicare providers, community health and mental health centers, pharmacies, and health insurance companies.
• Interpretation services must be free, accurate, and timely. The organization must provide a qualified interpreter.
• The organization may not require you to bring your own interpreter or pay for an interpreter.
• Having an accompanying adult interpret is allowed only temporarily in an emergency or when you specifically request it.
• Your child may not interpret for you; this is allowed only temporarily during an immediate emergency until a qualified interpreter arrives.
• If this right is violated, you may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights (OCR).

1. Save a photo of your insurance card on your phone. Note the customer service number and, if available, the nurse line number on the back of the card.
2. Find the nearest hospital and urgent care center in your plan’s network.
3. Choose a primary care provider and get your first preventive checkup.
4. Carry an English list of the medications you take, your allergies, and your chronic conditions.
5. Learn the copayment amounts for the emergency room, urgent care, and primary care provider from your Summary of Benefits and Coverage (SBC).
6. If your English is not sufficient at the hospital, say, “I need a Turkish interpreter.”
7. Compare the EOB and the bill you receive after treatment (see 9.5).

• Life-threatening emergency: 911
• Mental health crisis: 988 (call or text)
• Your insurance customer service: the number on the back of your card; in-network doctors and hospitals, prior authorization
• Find a community health center: HRSA Find a Health Center
• Interpreter rights complaint — HHS Office for Civil Rights (OCR)
  • Phone: +1 800 368 1019 (TDD: +1 800 537 7697)
  • Web: OCR complaint portal
• Surprise billing questions — No Surprises Help Desk: +1 800 985 3059 (see 9.5)

• Going to the emergency room for a non-emergency and receiving a high bill.
• Not going to the hospital during a real emergency because of concerns about insurance or immigration status.
• Signing the extended “notice and consent” form after stabilization without reading it.
• Going to an out-of-network urgent care center.
• Having a child or family member interpret instead of requesting a free interpreter.
• Not knowing whom to call when you first become ill because you have not chosen a primary care provider.
• Assuming that a ground ambulance is covered by surprise billing protections.

• I do not have insurance. Can the emergency room turn me away? No. A hospital with an emergency room that participates in Medicare must examine you and stabilize your emergency condition. Questions about payment cannot delay treatment.
• What is the difference between urgent care and the emergency room? Urgent care is for conditions that need prompt attention but do not require an emergency room. If there is a life-threatening emergency, go to the emergency room or call 911.
• I went to an out-of-network emergency room. Will I pay more? Your insurance cannot require a higher share for emergency room care, and in most cases the No Surprises Act protects you from out-of-network bills. Ground ambulances are excluded from this protection.
• Do I have to pay for an interpreter at the hospital? No. Health care organizations that receive federal financial assistance must provide a qualified interpreter free of charge.
• What happens if I go to the emergency room for labor? Labor is an emergency condition under EMTALA. For childbirth costs, see 8.2 Childbirth costs.
• Can I see an OB-GYN without a referral? Yes. You do not need a referral from a primary care provider for OB-GYN care.

• CMS – Your EMTALA rights (PDF)
• CMS – Overview of the EMTALA process (PDF)
• CMS – Surprise billing rights for insured people
• HRSA – Find a community health center
• HealthCare.gov – Free preventive services for adults
• eCFR – Interpreter rights under 45 CFR 92.201