Know your care options

Get the care you need, at the right time, in the right setting

Health care isn’t one-size-fits-all. At Harvard Pilgrim, we offer many ways for you to get the care you need when it’s convenient for you. This quick guide helps you select the right care for your specific needs, day or night, virtually or in-person.1

According to the New England Health Institute, 56% of all visits to the emergency room are avoidable.

Save time and money

Knowing your care options ahead of time can save you time and money. When you’re sick or injured, the last thing you want to worry about is where to go. The emergency room is the best option for care when a life-threatening illness or injury occurs, but when it’s not a life-threatening condition, visiting the emergency room can be time consuming and expensive.

Going to the emergency room for non life-threatening emergencies, on average, could cost over $2000 — that's 12 times higher than a PCP visit and 10 times higher than an urgent care visit.2

Quality care that meets your needs

From minor cuts to a sore throat or even a blood pressure check, knowing where to seek care for your situation can save you time and money. As a Harvard Pilgrim member, you and your dependents have access to a variety of options:

When you experience chest pain, difficulty breathing, suffer a broken bone, or if you think your life is in danger, you should always call 911 or go to the nearest emergency room.

For non-urgent needs such as preventive screenings, checkups, immunizations, or chronic conditions, your PCP knows your medical history and coordinates your care. Plus, your provider may also offer virtual health care services.

If you seek care outside of your PCP's office, please request that the provider share documentation with your PCP to better manage your care. Don’t have a PCP? Visit our provider lookup tool to search for PCPs near you.

You can stop by an urgent care center and be seen immediately without an appointment during evenings and weekends, for conditions that need immediate treatment but are not considered life-threatening. Examples include minor burns or cuts that may require stitches. Visit our provider lookup tool to search for an urgent center care near you.

Retail clinics such as CVS MinuteClinic® and Walgreens Healthcare Clinic are a good option when you’re experiencing mild symptoms such as an ear infection or skin conditions like poison ivy, and you want a health professional to check it out without an appointment. Visit our provider lookup tool to search for a retail clinic near you

You can request a virtual visit with a U.S.-based doctor 24/7 for non-emergency conditions such as upper respiratory infection, upset stomach or skin rash, using live video or voice call via your smartphone, tablet, or computer. You can also access confidential therapy and build an ongoing relationship with the provider of your choice; appointments are confirmed in less than 72 hours.3

Set up your Doctor On Demand, account with your Member ID Card

Download the app from Google Play or the Apple App Store

Need assistance managing a chronic condition, understanding costs related to health insurance or coordinating access to quality care? Our Care Team of registered nurses, clinical social workers and certified health coaches will answer your questions, help you navigate the healthcare system and support your health and wellness goals at no cost -- by phone email our mobile app. Login to your secure account to learn more.

Access to a national network

The Harvard Pilgrim PPO gives you access to care across the nation. Whether you’re on vacation or you and your family live out of New England, we have you covered. Our expansive national network extends from coast-to-coast providing you with better, seamless access to our provider network in Massachusetts, New Hampshire, Maine and UnitedHealthcare’s Options national network in the remainder of the states.

  • More than 1.2M providers and 6,700 hospitals
  • More easily accessible, affordable, and high-quality care
  • Visit our provider lookup tool to check your medical coverage and see which care options are in your network. By getting care from providers and facilities that are in your network, you’ll save money and avoid unexpected bills

Disclosures

1 This guide is for educational purposes only and does not constitute medical advice. Always seek the advice of a qualified health care provider. Cost share may apply, please refer to your plan documents for your specific benefit information.

2 2016 study in the Annals of Emergency Medicine.

3 Doctor On Demand virtual care services are available to Harvard Pilgrim members including members traveling internationally. excluding U.S. territories (Puerto Rico, Guam, U.S. Virgin Islands) and certain other countries (e.g., nations on the U.S. Sanctions List. Physicians will not order prescriptions for patients calling from outside the U.S.

Doctor On Demand physicians do not prescribe Schedule I-IV DEA controlled substances, and may elect not to treat or prescribe other medications based on what is clinically appropriate.

Doctor on Demand is not covered for Medicare Enhance members.