Your Kupat Cholim is required to have options and procedures in place for you to receive medical attention within a reasonable time 24 hours a day. Your local clinic is available daytime hours, and there are other options available during “off hours” that are subsidized by the kupat cholim. These other options include: urgent care centers, contracted private clinics and house-call companies.
Click here for a description of alternative medical services during “off hours”.
Even if you walk into the emergency room during off-hours you will still have to pay unless you have a referral or one of the conditions listed for exemption (see below). You should only go to the emergency room in a true emergency, not just because you need to see a doctor on short notice.
Click here for a description and listing of exemptions from Emergency Room costs.
In contrast to the emergency room, other options are covered by the Kupat Cholim (with a co-pay) provided you use them at the correct time. If you have the time and presence of mind in your condition, you should call your kupat cholim’s 24-hour number for directions (listed below). The operator can tell you where there are urgent care centers or other clinics you can go to in the area, and you can find out the hours and cost for the house call option. If the best option is to go to an emergency room, the operator’s referral is enough to guarantee coverage by the kupat cholim.
Of course, if the situation is truly urgent, and wasted time contributes to the danger, then you should not pause for these preliminaries. If you need an emergency room, that is where you should go without delay. If you are hospitalized from there, or if your condition matches any of those listed for automatic exemption, all fees will be covered by the Kupat Cholim, and if not, you can establish that the visit was “medically justified” after the fact and receive at least partial coverage.
It is also possible to face the expense of using an ambulance to get to the hospital, unless you are exempt. In this case too the gold standard for establishing that the ambulance evacuation was an emergency is if the patient was then hospitalized. Once again, one should not hesitate to call an ambulance when it is necessary, as an emergency situation should not be delayed.
Click here for a description and listing of exemptions from ambulance evacuation costs.