Guaranteed Access and Coverage

294 words | 2 minute read

TL;DR

• National laws mandate patient access to emergency care and prevent absurd bills - letting Yuzu members to forget about network in times of need.

More Info

Two federal laws help ensure all patients get emergency care while mandating health plan coverage.

EMTALA:

EMTALA requires hospitals provide the following access to all patients:

• Medical Screening Examination - guaranteeing patients are assessed for an emergency medical situation and then treated appropriately

• Stabilization - ensuring patients are stabilized and treated until they are able to be transferred or discharged without deteriorating

• Transfers - mandating hospitals to transfer patients to a higher level of care if medically necessary

No Surprises Act:

The No Surprises Act caps the amount a patient will have to pay.

• For emergency care, patients are only responsible for their in-network cost-sharing amounts, therefore:

• Members don’t need to worry about network in emergencies, they get treated at Yuzu’s standard coverage

Reminder

If you are experiencing a life-threatening emergency, always call 911 for guidance.

If you are experiencing a non-life-threatening emergency and are able, call Yuzu Support at ‪(203) 208-9898 immediately for guidance on where to seek care.

For urgent care or emergency medical admissions, Yuzu does not require pre-certification prior to you getting care.

‼️ Yuzu does require pre-certification by you or someone on your behalf within 24 hours after the admission date. This responsibility is typically handled by hospitals.

If the admission date is on a Friday or during the weekend, Yuzu requires pre-certification by you or someone on your behalf within 72 hours after the admission date, but no later than the first business day following the emergency admission.

Contact us

If you have questions, call us at ‪203-208-9898‬ or email us at support@yuzu.health. We respond ASAP, in most cases within minutes.