Medical Attention at Any Time
- 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 or run by the kupat cholim, including: urgent care centers, contracted private clinics, and house-call companies.
Terem is one example of a network of urgent care centers around the country. Payment arrangements vary by Kupah, location, and hours.
What about the emergency room?
- Even if you walk into the emergency room during off-hours, you will 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.
- If you do go to an emergency room, you can get a referral to guarantee coverage over the phone with the kupat cholim call center.
Urgent Care - Not 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, 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.
Check your kupah website BEFORE you have a crisis, to know where are your closest urgent care options.
Kupat Cholim's 24-hour telephone information centers:
- Clalit: *2700
- Maccabi: *3555
- Meuhedet: *3833
- Leumit: 1-700-507-507
- 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.
Exempt without referral
- New break/fracture.
- Acute shoulder or joint dislocation.
- Requiring stitches or other surgical suture.
- Inhalation of a foreign body.
- Eye penetration of a foreign body.
- Infant under 2 months sudden high fever
- Treatment for cancer related diseases.
- Treatment for hemophilia.
- Treatment for cystic fibrosis (CF)
- Women in labor
- Dialysis patients
- Domestic or sexual assault
What if you need an ambulance?
- It is also possible to face the expense of using an ambulance to get to the hospital, unless you are exempt.
- In this case to 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.
- Your kupat cholim is responsible for providing medical attention at any time of day.
- The emergency room can cost you plenty if you use it when it is not a true emergency.
- An ambulance should not be considered a convenient form of transportation to the hospital if it is not necessary.
- Do not hesitate to use emergency services in urgent situations!