Urgent and Emergency Care

AmeriHealth Caritas North Carolina members who require emergency care should be advised to call 911.

We help ensure emergency services and care are available 24 hours a day, seven days a week. We are responsible for coverage and payment of emergency and post-stabilization care services, regardless of whether the provider who furnishes the services has a contract with AmeriHealth Caritas North Carolina.

Definitions and requirements regarding urgent/emergent care are as follows:

Emergency medical conditions

An emergency medical condition is a physical or behavioral condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

• Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy.
• Serious impairment to bodily functions.
• Serious dysfunction of any bodily organ or part.

Emergency services

Emergency services are covered inpatient and outpatient services that are:

• Furnished by a provider who is qualified to furnish these services; and
• Needed to evaluate or stabilize an emergency medical condition.