Emergency Room Usage
COIHS has noticed that members are going to the Emergency Room for conditions which are not an emergency. To be considered an emergency the member must believe their health is in serious danger if they do not get help immediately. This can include the health of their unborn child.
Please educate your patients regarding the following:
- The member should call their PCP’s office if they are not sure if the condition is an emergency.
- Their PCP or an on-call provider is available 24 hours a day 7 days a week to coordinate their care.
- They should not go to the emergency room for care that should take place in the PCP’s office.
- They should not wait until after office hours to get care.
Office Wait Times
OAR 410-140-0220 (5)(C)(iii)(b) notes the following:
…If DMAP Members are kept waiting or if a wait of over 45 minutes from the time of a scheduled appointment is anticipated, DMAP Members shall be afforded the opportunity to reschedule the appointment…