Student Health Services provides coverage for emergency medical services to treat an emergency medical condition. Students should not go to an emergency room unless they are experiencing an emergency medical condition that requires emergency medical services.
Emergency medical condition means a medical condition manifesting itself by acute symptoms of sufficient severity such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention could reasonably be expected to result in:
- placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
- serious impairment to bodily functions; or
- serious dysfunction of any bodily organ or part.
Emergency medical services means an initial medical screening examination and such further examination and treatment as are required to stabilize the patient. To stabilize means to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility.
When Student Health Services is open, covered adults are encouraged to go to Student Health Services for medical emergencies and covered children should go to Forest Park Pediatrics offices. If Student Health Services or Forest Park Pediatrics is closed, covered persons are encouraged, but not required to, go to the Barnes-Jewish Hospital emergency room. Identify as covered under the WUSM Student Health Services Program and show a Medical Benefits Identification card.
Students must report all emergency room visits to Student Health Services within one business day of admission. Students will be responsible for charges incurred if they fail to comply with this notification requirement. Students will be required to pay a $50 copay for medical emergency expenses. Student Health Services will pay covered expenses in excess of the deductible at 80% of reasonable and customary charges and you will pay 20% of the covered expenses. If a student is admitted as an inpatient to a hospital directly from the emergency room, the student will not have to pay the copay for emergency health service. The benefits for an in-patient stay in a network hospital will apply instead.
The student also will be asked to assist in retrieving reports required from all medical care providers before bills can be processed for payment. Once the patient is stabilized, all other referral and approval requirements apply to any further medical care required because of the medical emergency. For example, once stabilized, students and covered dependents should seek care at Student Health Services or Forest Park Pediatrics, and fill any prescription through Student Health Services or the CAM as appropriate.
Following notice of a medical emergency, Student Health Services will cover the reasonable and customary charges for follow-up services of a doctor (but only if away from Saint Louis or unable to visit Student Health Services), x-rays, lab tests, and up to four physical therapy visits within 90 days of the date of the emergency room visit.