Urgently Needed Services a) The Contractor is responsible for Urgently Needed Services.
Urgently Needed Services. Covered Services required in order to prevent a serious deterioration of an HMO Member’s health that results from an unforeseen illness or injury if (i) such Member is temporarily absent from the Service Area and (ii) receipt of the health care service cannot be delayed until the Member’s return to the Service Area.
Urgently Needed Services. Payor shall pay for all Covered Services constituting Urgently Needed Services rendered to a Member. [42 C.F.R. § 422.100(b).]
Urgently Needed Services. Urgently Needed Services are defined as those services that are provided to you when:
Urgently Needed Services. Urgently Needed Services are defined as those services that are provided to you when: You are absent from the PACE CNY service area And You believe that the care cannot wait until you return to the PACE CNY service area, but the condition does not put your life or function in danger. Urgently Needed Services may be required due to an unforeseen illness, injury or condition. Fevers, abdominal pain, nausea and vomiting, and difficulty urinating are examples of Urgently Needed Service situations. PACE CNY will cover Urgently Needed Services when such services arenecessary, immediately required, and PACE CNY has given prior authorization to receive the services. In order to ensure that unforeseen circumstances do not result in delays in needed care, PACE CNY must cover urgently needed services if it does not respond to a request for approval within one hour after being contacted, or if PACE CNY cannot be contacted for approval. If Urgently Needed Services are required, please call PACE CNY 24 hours a day, seven days a week, and 365 days a year: Telephone: (000) 000-0000 OR Outside of the local area, Call Toll Free: 0-000-000-0000 Request to speak to the clinic RN Monday through Friday 8:00 a.m. to 5:00 p.m. During off-hours or weekends or holidays, you will speak with the On-Call RN. Briefly describe your situation. The On-Call RN will contact the primary care physician, who will advise you what to do and make necessary arrangements for you to receive the care you need. When you receive emergency, post stabilization or urgently needed out-of-network services, the doctor or hospital that provides the service should xxxx XXXX CNY. If you mistakenly receive a bill, give it to PACE CNY.
Urgently Needed Services. Covered Services that are not Emergency Services, provided when a Member is temporarily absent from the licensed service area (or, if applicable, Continuation Area) (or provided when a Member is in the licensed service area or Continuation Area, but Cigna-HealthSpring’s provider network is temporarily unavailable or inaccessible) when such services are Medically Necessary and immediately required as a result of an unforeseen illness, injury, or condition, and it was not reasonable given the circumstances to obtain the services from a Cigna-HealthSpring Participating Provider. [42 C.F.R. § 422.113(b)(1)(iii).]
Urgently Needed Services. Cigna-HealthSpring shall pay for all Covered Services constituting Urgently Needed Services rendered to a Member. [42 C.F.R. § 422.100(b).]
Urgently Needed Services. Urgently Needed Services are defined as those services, which require immediate medical attention due to unexpected illness and injury. If out of area, urgent care may be required when an illness or injury is too severe to postpone treatment until return- ing to the service area, but life or function is not in severe jeopardy. If urgently needed services are required, please call Eddy SeniorCare 24 hours a day, seven days a week, 365 days a year. Telephone: (000) 000-0000 or toll-free: 0-000-000-0000 Nurses are available Monday through Friday 8:00 AM to 4:30 PM. During off-hours, weekends or holidays, an on-call nurse may be contacted. The nurse may contact the primary care physician who will advise or make the necessary arrangements for the care needed. Should Eddy SeniorCare not respond to your concern within 1 hour you may go to any healthcare provider and Eddy SeniorCare assumes responsibility for the cost of care. Fevers, abdominal pain, nausea and vomiting and difficulty urinating are some exam- ples of urgently needed service situations. Eddy SeniorCare covers urgently needed services both in and out of the service area when such services are necessary and im- mediately required. When emergency care, post stabilization care, or urgent care has been provided, the doctor or hospital that provided such services may xxxx you. Forward any bills re- ceived to Eddy SeniorCare for processing and keep a copy for your records.
Urgently Needed Services. Contracted Services, that are not Emergency Services, provided when a MA Member is temporarily absent from MA HEALTH PLAN’s service (or continuation) area (or, under unusual and extraordinary circumstances, provided when the MA Member is in MA HEALTH PLAN’s service or continuation area but MA HEALTH PLAN’s provider network is temporarily unavailable or inaccessible) when the services are Medically Necessary and immediately required (a) as a result of an unforeseen illness, injury or condition; and (b) it was not reasonable given the circumstances to obtain the services through MA HEALTH PLAN.
Urgently Needed Services. Covered Medical Services provided when a Medicare+Choice Member is temporarily absent from the RPO Service Area (or, if applicable, Continuation Area) (or, under unusual and extraordinary circumstances, provided when a Medicare+Choice Member is in the RPO Service Area or Continuation Area, but Texas HealthSpring's provider network is temporarily unavailable or inaccessible) when such services are Medically Necessary and required without delay in order to prevent the serious deterioration of a Medicare+Choice Member's health as a result of an unforeseen illness, injury, or condition and it was not reasonable given the circumstances to obtain the services through Texas HealthSpring.
