Post-Stabilization Care means Medically Neces- sary services received after the treating physician determines the emergency medical condition is stabilized.
Post-Stabilization Care means Services you receive for the acute episode of your Emergency Medical Condition after that condition is Clinically Stable. (“Clinically Stable” means that no material deterioration of the Emergency Medical Condition is likely, within reasonable medical probability, to result from or occur during your discharge or transfer from the hospital).
Post-Stabilization Care means Medically Necessary services received after the treating Physician determines the Emergency Medical Condition is stabilized.
Examples of Post-Stabilization Care in a sentence
This includes ensuring the determination of the attending emergency physician, or the Provider actually treating the Dental Health Plan Enrollee, of when the Dental Health Plan Enrollee is sufficiently stabilized for transfer or discharge is binding on the Contractor and State for coverage and payment of Emergency and Post-Stabilization Care Services.
In accordance with 42 C.F.R. §§ 438.114(e) and 422.113(c)(2)(iv), the Contractor shall limit charges to Dental Health Plan Enrollees for Post-Stabilization Care Services to an amount no greater than what the Contractor would charge the Dental Health Plan Enrollee if he or she obtained the services through the Contractor.
In accordance with 42 C.F.R. §§ 438.114(e) and 422.113(c)(3)(i) - (iv), the Contractor’s financial responsibility for Post-Stabilization Care Services if not pre-approved ends when: • A Contractor physician with privileges at the treating hospital assumes responsibility for the Dental Health Plan Enrollee’s care.
Post-stabilization Services In accordance with 42 C.F.R. §§ 438.114(e), 422.113(c)(2)(i) - (ii), and 422.113(c)(2)(iii)(A) - (C), the Contractor shall cover Post-Stabilization Care Services that are: • Obtained within or outside the Contractor network that are: o Pre-approved by a Contractor Provider or representative.
In accordance with Section 1852(d)(2) of the Act and 42 C.F.R. §§ 438.114(b), 422.113(c), 438.114(d), and 438.114(e), the Contractor must cover and pay for Emergency and Post-Stabilization Care Services.
More Definitions of Post-Stabilization Care
Post-Stabilization Care means Medically Necessary ser- vices received after the treating physician determines the emergency medical condition is stabilized.
Post-Stabilization Care means Medically Nec- essary services received after the treating physi- cian determines the emergency medical condition is stabilized.
Post-Stabilization Care means Medically Necessary services received after the treating physician determines the emergency medical condition is stabilized. Experimental or Investigational in Nature — any treatment, therapy, procedure, drug or drug usage, facility or facility usage, equipment or equipment usage, device or device usage, or supplies which are not recognized in accordance with generally accepted professional medical standards as being safe and effective for use in the treatment of the illness, injury, or condition at issue. Services which require approval by the Federal government or any agency thereof, or by any state government agency, prior to use and where such approval has not been granted at the time the services or supplies were rendered, shall be considered experimental or investigational in nature. Services or supplies which themselves are not approved or recognized in accordance with accepted professional medical standards, but nevertheless are authorized by law or by a government agency for use in testing, trials, or other studies on human patients, shall be considered experimental or investigational in nature. Family — the Subscriber and all enrolled Dependents. Formulary — A comprehensive list of preferred Generic and Brand Drugs maintained by Blue Shield’s Pharmacy and Therapeutics Committee for use under the Blue Shield Outpatient Prescription Drug Benefits, which is designed to assist Physicians in prescribing Drugs that are Medically Necessary and cost effective. The Formulary is updated periodically. Generic Drugs — Drugs that (1) are approved by the Food and Drug Administration (FDA) or other authorized government agency as a therapeutic equivalent or authorized generic to the Brand Drug, (2) contain the same active ingredient as the Brand Drug, and (3) typically cost less than the Brand Name Drug equivalent. Habilitation Services – Medically Necessary services and health care devices that assist an individual in partially or fully acquiring or improving skills and functioning and that are necessary to address a health care condition, to the maximum extent practical. These services address the skills and abilities needed for functioning in interaction with an individual’s environment. Respite care, day care, recreational care, Residential Care, social services, Custodial Care, or education services of any kind are not considered Habilitative Services. Hemophilia Infusion Provider — a provider that furnishes blood factor replacement products and serv...
Post-Stabilization Care. EOC section has been modified. For all plans, prior authorization for Post Stabilization Care from a Non-Participating Facility or Non-Participating Provider must be obtained no later than 24 hours after any admission, or as soon as reasonably possible. For three tier Added Choice Plans, this also applies when obtaining prior authorization for Post Stabilization Care from PPO Facilities or PPO Providers. Coverage for Post-Stabilization Care at a Non-Participating Facility or a Non-Participating Provider is limited to the Allowed Amount. The "Mental Health Services Exclusions and Limitations" EOC section has been modified. Treatment for paraphilia diagnostic code 302.9 is excluded from coverage. The "Outpatient Prescription Drugs and Supplies" and the "Transplant Services" EOC sections have been modified. Post-surgical immunosuppressive drugs are subject to Deductible, Copayment, and/or Coinsurance amounts for the applicable prescription drug tier.
Post-Stabilization Care means Medically Necessary services received after the treating physician determines the emergency medical condition is stabilized. Experimental or Investigational in Nature — any treatment, therapy, procedure, drug or drug usage, facility or facility usage, equipment or equipment usage, device or device usage, or supplies which are not recognized in accordance with generally accepted professional medical standards as being safe and effective for use in the treatment of the illness, injury, or condition at issue. Services which require approval by the Federal government or any agency thereof, or by any state government agency, prior to use and where such approval has not been granted at the time the services or supplies were rendered, shall be considered experimental or investigational in nature. Services or supplies which themselves are not approved or recognized in accordance with accepted professional medical standards, but nevertheless are authorized by law or by a government agency for use in testing, trials, or other studies on human patients, shall be considered experimental or investigational in nature. Family — the Subscriber and all enrolled Dependents. Formulary — A comprehensive list of preferred Generic and Brand Drugs maintained by Blue Shield’s Pharmacy and Therapeutics Committee for use under the Blue Shield Outpatient Prescription Drug Benefits, which is designed to assist Physicians in prescribing Drugs that are Medically Necessary and cost effective. The Formulary is updated periodically.
Post-Stabilization Care means Services you receive for the acute episode of your Emergency Medical Condition after that condition is Clinically Stable. (“Clinically Stable” means that no material deterioration of the Emergency Medical Condition is likely, within reasonable medical probability, to result from or occur during your discharge or transfer from the hospital). With respect to a pregnant woman who is having contractions, when there is inadequate time to safely transfer her to another hospital before delivery (or the transfer may pose a threat to the health or safety of the woman or unborn child), Clinically Stable means after delivery (including the placenta).
Post-Stabilization Care means Medically Neces- sary services received after the treating physician