Understanding How to Get the Right Health Care

Understanding how to get the right health care

Aetna Better Health® of Nebraska 15950 West Dodge Road Omaha, NE 68118 www.aetnabetterhealth.com/nebraska Visit our KidsHealth page

Important numbers

Aetna Better Health® of Nebraska Member Services 1-888-784-2693 (TTY: 711 or TDD: 1-800-877-8973)

Aetna Better Health Informed Health® Line 1-800-556-1555 (TTY: 711)

Emergencies: Dial 911

Getting the right care at the right place

Even healthy people get hurt or sick. If your child has a bump or bruise, or you have a cold, you can often take care of it at home. You might just need a Band-Aid, cough drops or a cup of hot soup. In other cases, however, you may need to call your Primary Care Provider (PCP), or go straight to the emergency room. Different problems require different levels of care. So what is the right level of care?

It’s important to know your options for medical care before you need it. You want to get the right care at the right time at the right place. Use the chart below to help guide you.

(In boxes above the chart – see “It’s all about you” brochure)

Primary care provider (PCP) If you have a minor illness like a cough, sore throat, or rash, call your PCP for an appointment. Your PCP should provide most of your care. This includes checkups or ongoing care for any medical condition you have. You can find a provider at www.aetnabetterhealth.com/nebraska.

Informed Health® Line 1-800-556-1555 (TTY: 711) Call our Informed Health Line anytime you can’t get in touch with your PCP. You can get free telephone advice from registered nurses 24/7. Nurses can answer questions when you or an enrolled family member is sick or hurt. They can help you decide whether you need to see your provider or go to an urgent care clinic -- or if you can treat the problem at home.

Urgent Care clinics An urgent care clinic is a place you can go when you can’t see your PCP. You can get help with something that needs immediate attention, like a possible broken bone. These conditions are not life-threatening. Remember, urgent care clinics should NOT be used for routine care that can be scheduled with your PCP.

Emergency rooms The emergency room is for serious medical conditions. These conditions could result in permanent harm or death if not treated immediately. Don’t use emergency care for routine care you can schedule with your PCP. If you’re not sure if you need emergency care, just call your PCP or the Informed Health® Line.

Symptom Primary Care Aetna Better Health Urgent Care Emergency Room Provider (“PCP”) Informed Health® Line $ √ √ $$ √ √ $$$$ √√√√ Colds, Flu, and Fever X X X Cough/Sore Throat X X X Earache/Toothache X X X Rash X X X Minor Cuts/Burns X X X Minor Pain/Bleeding X X X Sprains X X X Chest Pain X Convulsions or Seizures X Poisoning X Severe Cuts/Burns X Severe Pain/Bleeding X

Should I go to the emergency room? Remember to go to the emergency room (ER) only for true emergencies. ERs can be crowded. Often, it takes a long time for minor problems to be treated. However, if it’s a true medical emergency the ER is the best place to get care.

Here are some reasons to go to the ER : • Difficulty breathing or shortness of breath • A sudden change where the person is unusually sleepy, difficult to wake, or very confused • A cut that is bleeding and won't stop • A stiff neck along with a fever • A rapid heartbeat that doesn't slow down • Possibility of accidental poisoning or taking too much medication

In certain situations, you should dial 911 to get an ambulance instead of going to the ER yourself. Call 911 if there is: • Trouble breathing or the person is turning blue • A car accident and someone is unconscious or badly hurt • a seizure that lasts 3-5 minutes, with difficulty breathing, or the person is turning blue • Loss of consciousness or no response • Neck or spine injury • A head injury with a loss of consciousness, persistent vomiting, or the person is not responding normally • Heavy bleeding that won’t stop • A possible poisoning where the person is not responding or having difficulty breathing (In any possible poisoning, call the Poison Control Center (1-800-222-1222) for expert advice. They may direct you to the ER.)

When in doubt, call your PCP. If your PCP isn't available, the office nurse can talk with you and determine whether you should go to the ER. On weekends and at night, PCPs have answering services that allow them to get in touch with you if you leave a message.

Always be prepared • Always keep your Aetna Better Health Member ID card and State Medicaid ID card with you. They have important phone numbers on them, such as your PCP, Member Services and transportation.

• Know where your closest urgent care centers and emergency departments are located. Go to www.aetnabetterhealth.com/nebraska for a full list of providers.