Receiving Care

When to go to urgent care

Urgent care is care you need sooner than a routine visit to a doctor. Urgent care is not emergency care. Urgent care is for illnesses or injuries that you would normally receive care for at your regular doctor’s office. Urgent care clinics are available when most other doctors’ offices are closed. Do not go to an emergency room for urgent care unless your doctor tells you to do so.

You may need urgent care for:

  • Ear infections with pain and/or fever
  • Sore throat Cold or flu
  • Repeated vomiting and diarrhea (especially in babies and small children)
  • Non-severe bleeding
  • Minor burns or cuts
  • Hives, rash or diaper rash
  • Bruises or sprains
  • Lice, scabies or ringworm
  • Drug reactions

When to go to the emergency room:

A medical emergency is an illness, injury, symptom or condition that is so serious that you need to seek care right away to avoid severe harm.

You need emergency care for:

  • Serious broken bones
  • Gun or knife wounds
  • Severe or unusual bleeding that will not stop
  • Severe burns
  • Heart attack or severe chest pain
  • Suspected stroke
  • Sudden inability to see, move or speak
  • Choking or trouble breathing
  • Possible poisoning
  • Unconsciousness
  • Convulsions or prolonged, repeated seizures
  • Going into labor
  • Drug overdose
  • Major injuries Severe pain

Emergency Coverage

Always keep your health insurance card with you when traveling. Your health insurance card has valuable information should you need health care services. Follow these rules if you need medical care but are too far away from home to go to your in-network hospital. For emergencies go to the nearest hospital, or call 911, as appropriate. For out-of-network follow-up care after an emergency room visit, please first contact 1-844-201-4672. For urgent care, go to the nearest urgent care clinic, as appropriate. To submit a claim from an out-of-network provider, please obtain an itemized bill from each health care provider, have the bill(s) translated into English, if necessary, and submit to Together with CCHP for reimbursement. Send these bills to: Together with CCHP P.O. Box 106013 Pittsburgh, PA 15230-6013 Call CCHP Customer Service at 1-844-201-4672 if you need additional help with submitting these claims. TTY users may call 1-844-531-4856. You can reach us Monday through Friday from 8:00 a.m. to 6:00 p.m., Saturday from 8:00 a.m. to 2:00 p.m.

Balance Billing

There is no coverage available outside of the service area, unless it is an emergency or if prior authorization has been obtained. If a member is outside of the service area, or if a member is in the service area, but is seeking coverage by an out-of-network provider, and it is not an emergency, and prior authorization has not been obtained, that member will be responsible for all related fees and expenses. This may result in additional out-of-pocket expense or being Balance Billed by the provider. When you receive benefits from an out-of-network provider, such as in an emergency or urgent situation, CCHP will seek to reimburse the out-of-network provider using the maximum allowed amount if a negotiated rate is not available. CCHP will reimburse the out-of-network provider up to the maximum allowed amount under your plan if a negotiated rate is not available, and you will be responsible for the remainder of the billed amount.

CCHP on Call Nurseline

Not sure if you need to go to urgent care? Trained nurses are available 24/7 to help assess your symptoms from the comfort of your home. Give the CCHP on Call nurseline a call today - 877-257-5861

Always use in-network providers

For the most up-to-date listing of urgent care and emergency providers, please review our Provider Directory.