Members are required to use a network hospital for inpatient coverage except in what situation?

Members are required to use a network hospital for inpatient coverage except in the case of an emergency. In emergency situations, the need for immediate medical attention takes precedence over network restrictions. This policy allows members to receive necessary care without delay, regardless of whether the hospital is part of the network. An emergency typically involves circumstances where a delay in treatment could lead to serious harm or worsening of a medical condition, necessitating immediate access to any available medical facility.

In contrast, routine check-ups, scheduled procedures, and urgent care situations generally involve planning and do not represent the same level of urgency as emergencies. Therefore, these scenarios typically require using an in-network provider to ensure coverage and reduce out-of-pocket costs.