Recommended Treatment. KFHPWA’s medical director will determine the necessity, nature and extent of treatment to be covered in each individual case and the judgment will be made in good faith. Members have the right to appeal coverage decisions (see Section VIII.). Members have the right to participate in decisions regarding their health care. A Member may refuse any recommended services to the extent permitted by law. Members who obtain care not recommended by KFHPWA’s medical director do so with the full understanding that KFHPWA has no obligation for the cost, or liability for the outcome, of such care.
Recommended Treatment. KFHPWA’s medical director will determine the necessity, nature and extent of treatment to be covered in each individual case and the judgment will be made in good faith. Members have the right to appeal coverage decisions (see Section VIII.). Members have the right to participate in decisions regarding their health care. A Member may refuse any recommended services to the extent permitted by law. Members who obtain care not recommended by KFHPWA’s medical director do so with the full understanding that KFHPWA has no obligation for the cost, or liability for the outcome, of such care. New and emerging medical technologies are evaluated on an ongoing basis by the following committees – the Interregional New Technologies Committee, Medical Technology Assessment Committee, Medical Policy Committee, and Pharmacy and Therapeutics Committee. These physician evaluators consider the new technology’s benefits, whether it has been proven safe and effective, and under what conditions its use would be appropriate. The recommendations of these committees inform what is covered on KFHPWA health plans.
Recommended Treatment. Group Health’s medical director will determine the necessity, nature and extent of treatment to be covered in each individual case and the judgment will be made in good faith. Members have the right to appeal coverage decisions (see Section VIII.). Members have the right to participate in decisions regarding their health care. A Member may refuse any recommended services to the extent permitted by law. Members who obtain care not recommended by Group Health’s medical director do so with the full understanding that Group Health has no obligation for the cost, or liability for the outcome, of such care.
Recommended Treatment. GHC’s Medical Director or his/her designee will determine the necessity, nature and extent of treatment to be covered in each individual case and the judgment, made in good faith, will be final. Members have the right to participate in decisions regarding their health care. A Member may refuse any recommended treatment or diagnostic plan to the extent permitted by law. Members who obtain care not recommended by GHC, do so with the full understanding that GHC has no obligation for the cost, or liability for the outcome, of such care. Coverage decisions may be appealed as set forth in Section VI. Major Disaster or Epidemic. In the event of a major disaster or epidemic, GHC will provide coverage according to GHC’s best judgment, within the limitations of available facilities and personnel. GHC has no liability for delay or failure to provide or arrange Covered Services to the extent facilities or personnel are unavailable due to a major disaster or epidemic. Unusual Circumstances. If the provision of Covered Services is delayed or rendered impossible due to unusual circumstances such as complete or partial destruction of facilities, military action, civil disorder, labor disputes or similar causes, GHC shall provide or arrange for services that, in the reasonable opinion of GHC's Medical Director, or his/her designee, are emergent or urgently needed. In regard to nonurgent and routine services, GHC shall make a good faith effort to provide services through its then-available facilities and personnel. GHC shall have the option to defer or reschedule services that are not urgent while its facilities and services are so affected. In no case shall GHC have any liability or obligation on account of delay or failure to provide or arrange such services.
Recommended Treatment. Under the MHCN option, GHO’s Medical Director, or his/her designee will determine the necessity, nature and extent of treatment to be covered under the MHCN benefit in each individual case and the judgment, made in good faith, will be final. Members have the right to participate in decisions regarding their health care. A Member may refuse any recommended treatment or diagnostic plan to the extent permitted by law. Members who obtain care not recommended by GHO, do so with the full understanding that such care will not be covered at the MHCN benefit level. Coverage decisions may be appealed as set forth in Section VI. Major Disaster or Epidemic. In the event of a major disaster or epidemic, GHO will pay benefits for Covered Services through the MHCN according to GHO’s best judgment, within the limitations of available MHCN Facilities and personnel. GHO has no liability for delay or failure to provide or arrange Covered Services to the extent facilities or personnel are unavailable due to a major disaster or epidemic. Unusual Circumstances. Under the MHCN option, if the provision of Covered Services is delayed or rendered impossible due to unusual circumstances such as complete or partial destruction of MHCN Facilities, military action, civil disorder, labor disputes or similar causes, GHO shall ensure that its MHCN provide and arrange for services that, in the reasonable opinion of GHO’s Medical Director, or his/her designee, are emergent or urgently needed. In regard to nonurgent and routine services, GHO shall make a good faith effort to make the then-existing MHCN Facilities and personnel available. The MHCN shall have the option to defer or reschedule services that are not urgent while its facilities and services are so affected. In no case shall GHO have any liability or obligation on account of delay or failure to provide or arrange such services. Under the Community Provider option, if the provision of Covered Services is delayed or rendered impossible due to unusual circumstances such as military action, civil disorder, labor disputes, or similar causes, in no case shall GHO have any liability or obligation on account of delay.
Recommended Treatment. GHC’s Medical Director or his/her designee will determine the necessity, nature and extent of treatment to be covered in each individual case and the judgment, made in good faith, will be final. Members have the right to participate in decisions regarding their health care. A Member may refuse any recommended treatment or diagnostic plan to the extent permitted by law. Members who obtain care not recommended by GHC, do so with the full understanding that GHC has no obligation for the cost, or liability for the outcome, of such care. Coverage decisions may be appealed as set forth in Section VI.
Recommended Treatment. General symptomatic and supportive measures should be used along with immediate gastric lavage where appropriate. Intravenous fluids should be administered as needed. Flumazenil may be useful. As in all cases of drug overdose, respiration, pulse, blood pressure, and other appropriate signs should be monitored and general supportive measures employed. Hypotension and CNS depression should be monitored and treated by appropriate medical intervention. The value of dialysis in the treatment of overdosage has not been determined. Poison Control Center As with the management of all overdosage, the possibility of multiple drug ingestion should be considered. The physician may wish to consider contacting a poison control center for up-to-date information on the management of hypnotic drug product overdosage.
