ALTERNATIVE TREATMENT PLANS. Notwithstanding anything under this coverage to the contrary, Keystone, in its sole discretion, may elect to provide benefits pursuant to an approved alternative treatment plan for services that would otherwise not be covered. Such services require Preauthorization from Keystone. All decisions regarding the treatment to be provided to a member remain the responsibility of the treating physician and the member. If Keystone elects to provide alternative benefits for a Member in one instance, it does not obligate Keystone to provide the same or similar benefits for any member in any other instance, nor can it be construed as a waiver of Keystone’s right to administer this coverage thereafter in strict accordance with its express terms. SECTION ACC - ACCESS TO PRIMARY CARE, SPECIALIST AND HOSPITAL CARE NETWORK DIRECT ACCESS TO CERTAIN CARE A Member does not need a Referral from his/her Primary Care Physician for the following Covered Services obtained from a Participating Provider in the network for Keystone’s Limited Network Area: Emergency Services Care from a participating obstetrical/gynecological Specialist Mammograms Inpatient Hospital Services that require Preauthorization. Dialysis services performed in a Participating Facility Provider or by a Participating Professional Provider SELECTION OF A PRIMARY CARE PHYSICIAN Prior to the time a Member's coverage becomes effective in accordance with the provisions of this Agreement, the Member must choose a Participating Primary Care Physician (PCP) in the network for Keystone’s Limited Network Area from whom the Member wishes to receive Covered Services under this Agreement. If the Member is a minor or otherwise incapable of selecting a PCP, the Subscriber or legal guardian should select a PCP on the Member's behalf. A Member may designate any Participating Primary Care Physician who is available to accept Members as the Member’s Primary Care Physician. If the Member is a minor, the Subscriber or legal guardian may select a pediatrician as the Member’s PCP. At the new Member's option and subject to the Non-Participating Provider's agreement to certain terms and conditions, the Member may continue an ongoing course of treatment with a Non- Participating Provider for a period of up to ninety (90) days from the Member's Effective Date of Coverage (See Continuity of Care provision below). If a Member fails either to select a Primary Care Physician or complete a Continuity of Care form within thirty
ALTERNATIVE TREATMENT PLANS. Notwithstanding anything under this coverage to the contrary, Keystone, in its sole discretion, may elect to provide Benefits, including but not limited to select products which do not legally require a prescription, pursuant to an approved alternative treatment plan for services that would otherwise not be covered. Such services require Prior Authorization from Keystone. All decisions regarding the treatment to be provided to a Member remain the responsibility of the treating Physician and the Member. If Keystone elects to provide alternative Benefits for a Member in one instance, it does not obligate Keystone to provide the same or similar Benefits for any Member in any other instance, nor can it be construed as a waiver of Keystone’s right to administer this coverage thereafter in strict accordance with its express terms.
