Inpatient and outpatient services needed to treat a medical emergency
L.A. Care covers all services that are needed to treat a medical emergency that happens in the U.S. (including territories such as Puerto Rico, U.S. Virgin Islands, etc.). L.A. Care also covers emergency care that requires hospitalization in Canada or Mexico.
A medical emergency is a medical condition with severe pain or serious injury. The condition is so serious that, if it does not get immediate medical attention, a prudent (reasonable) layperson (not a health care professional) could expect it to result in:
- Serious risk to your health; or
- Serious harm to bodily functions; or
- Serious dysfunction of any bodily organ or part; or
- Serious risk in cases of a pregnant person in active labor, meaning labor at a time when either of the
following would occur:- There is not enough time to safely transfer you to another hospital before delivery.
- The transfer might pose a threat to your health or safety or to that of your unborn child.
If a hospital emergency room provider gives you up to a 72-hour supply of an outpatient prescription drug as part of your treatment, L.A. Care will cover the prescription drug as part of your covered Emergency Services. If a hospital emergency room provider gives you a prescription that you have to take to an outpatient pharmacy to be filled, Medi-Cal Rx will cover that prescription.
If a pharmacist at an outpatient pharmacy gives you an emergency supply of a medication, that emergency supply will be covered by Medi-Cal Rx and not L.A. Care.
If the pharmacy needs help giving you an emergency medication supply, have them call Medi-Cal Rx at 1-800-977-2273.
Emergency transportation services
L.A. Care covers ambulance services to help you get to the nearest place of care in an emergency.
This means your condition is serious enough that other ways of getting to a place of care could risk your health or life. No services are covered outside the U.S., except for emergency services that require you to be in the hospital in Canada or Mexico.
If you get emergency ambulance services in Canada or Mexico and you are not hospitalized during that care episode, L.A. Care will not cover your ambulance services.