Continued Care. Where a Member is in the midst of a course of treatment from a UPMC Provider that is an Out-of-Network Provider under this Agreement, the Member may, at his/her option, request to continue treatment with that UPMC Provider. Covered Services shall be available at the Standard Value level of benefits. The need for a continuing course of treatment with a UPMC Provider shall be determined, in the first instance, by the Member’s treating Physician acting in consultation and in accordance with the wishes of the Member or the Member’s authorized representative. A Member with a pregnancy that has been confirmed before December 31, 2015 or who has started a continuing course of treatment for a chronic or persistent medical condition with a UPMC Provider in calendar years 2013, 2014 or 2015 (or on or before June 30, 2016 for UPMC Mercy) may continue treatment with that UPMC Provider through the period of delivery and post-partum care for that pregnancy or completed treatment of the chronic or persistent medical condition. Notwithstanding the above, a Member who was treated at UPMC Mercy and by a UPMC Mercy Physician for a confirmed pregnancy on or before June 30, 2016, may continue to receive treatment at UPMC Mercy through the period of delivery and post-partum care for that pregnancy or completed treatment of the chronic or persistent medical condition. Services such as routine wellness care and routine preventive care are not considered to be continued care under this Paragraph. Furthermore, benefits will not be provided under this Paragraph when the course of treatment for a chronic or persistent medical condition started before January 1, 2013 but for which no treatment was subsequently received from a UPMC Provider, unless the UPMC Provider can demonstrate that the Member was receiving ongoing care in accordance with recognized medical protocols and/or standards. While undergoing a continuing course of treatment with such UPMC Provider, benefits will include all Covered Services reasonably related to the treatment including, but not limited to, testing and follow-up care. In the event that the Plan disputes the opinion of the treating Physician that a continuation of care is Medically Necessary and Appropriate, or disputes the scope of that care, the Pennsylvania Department of Health or its designated representative will review that matter and make a final non-appealable determination.
Continued Care. Practitioner agrees that: (i) Covered Services provided to Participants hereunder shall continue for all Participants for the duration of the Humana Medicare contract period for which CMS payments have been made to Humana; and (ii) in the event of Humana insolvency or termination of the Humana Medicare contract for any reason, Covered Services shall continue until the date of discharge for any Participant confined in an inpatient facility on the effective date of insolvency or termination.
Continued Care. In addition to PBM's and PBM Contracting Providers' obligations pursuant to Section 3.8 of the Agreement, PBM shall, and shall require PBM Contracting Providers to, provide Covered Services to Medicare Members (i) for all Medicare Members, for the duration of the M+C Contract period for which HCFA payments have been made; and (ii) for Medicare Members who are hospitalized on the date the M+C Contract terminates or in the event of Health Plan's or PBM's insolvency, through discharge. This provision shall survive termination of the Agreement.
Continued Care. In the event this Agreement is terminated, the delivery of written notice of intent to terminate will not excuse Provider from continuing to treat Covered Persons prior to the effective date of such termination, or from cooperating in the orderly transfer of Covered Persons and copies of their medical records to other providers participating in the appropriate Health Benefit Program. Provider agrees that, except as otherwise required by statue or regulation, in the event of Crystal Run’s insolvency or the termination of this Agreement for any reason, Provider will continue to provide Covered Services to Covered Persons who were confined in an inpatient facility or were engaged in receiving a course of treatment at the time this Agreement was terminated. Provider will continue to provide medically appropriate care to such Covered Person until medically appropriate discharge or transfer, or completion of the course of treatment, whichever first occurs. Provider will be paid for such services, to the extent that they would be Covered Services, at the same rates applicable immediately prior to the termination of this Agreement. Notwithstanding the foregoing, in the event Crystal Run is unable to transfer the Covered Person’s care to another Participating Provider due to geographic or travel-time barriers, or contractual restrictions, Provider will continue to accept, throughout the continued course of care, the same rates applicable immediately prior to the termination of this Agreement. Provider continues to be responsible for ensuring Covered Person’s eligibility during such continuity of care periods, including coverage verification. This provision will survive the termination of this Agreement for any reason.
Continued Care. The buyer agrees to provide the kitten/cat, throughout its lifetime, proper food, accommodations, vet examinations and vaccinations, as well as ongoing vet care as and when needed. I, (buyer), (Please Print) am in full agreement with and agree to abide with all the above terms and conditions of this contract.
