Continued Stay Review Sample Clauses

Continued Stay Review. Network and Out-of-Network Services The medical progress of patients is reviewed to identify the continued Medical Necessity and Appropriateness of the Inpatient stay. If a Member elects to continue to receive Inpatient Services after receipt of written notification from the Plan that such level of care is no longer Medically Necessary and Appropriate, the Member will be financially responsible for the full amount of the Provider’s charges from the date appearing on the written notification.

Continued Stay Review. The medical progress of patients is reviewed to identify the continued Medical Necessity and Appropriateness of the Inpatient stay. If a Member elects to continue to receive Inpatient Services after receipt of written notification from the Plan that such level of care is no longer Medically Necessary and Appropriate, the Member will be financially responsible for the full amount of the Provider’s charges from the date appearing on the written notification.

Continued Stay Review. Each approved admission of a Member is contemplated to last a particular number of days. Accordingly, each admission will be assigned a specific number of days at the time of approval of the admission. Additional days are subject to a Continued Stay Review and approval by CBA. Clinician will cooperate with other Network Providers in connection with a Continued Stay Review, including providing any necessary clinical information relating to a Member’s proposed continued stay.

Continued Stay Review the review that must be obtained by a Member (or the Member’s Authorized Representative) regarding an extension of an Admission to determine if an Admission for longer than the time that was originally Preauthorized is Medically Necessary. The Continued Stay Review process is outlined in Article III. Contract: the Master Group Contract between the Corporation and the Employer including the Employer Application, Benefits Checklist, Plan of Benefits and all endorsements, amendments, riders or addenda. Copayment: the amount, if any, specified on the Schedule of Benefits that the Member must pay directly to the Provider each time the Member receives Benefits. Corporation: Blue Cross and Blue Shield of South Carolina. Covered Expenses: the amount payable by the Corporation for Benefits. The amount of Covered Expenses payable for Benefits is determined as set forth in this Plan of Benefits and at the percentages set forth on the Schedule of Benefits. Covered Expenses are subject to the limitations and requirements set forth in this Plan of Benefits and on the Schedule of Benefits. Covered Expenses will not exceed the Allowable Charge. Credit(s): rebates and/or other amounts which may be received by the Corporation from drug manufacturers, a Pharmacy Benefit Manager and/or another third party. Credits are not payable to Members and will be retained by the Corporation to help stabilize overall rates and to offset expenses. Reimbursements to a Participating Pharmacy or discounted prices charged at pharmacies are not affected by these Credits. Any Coinsurance or Copayment that a Member must pay for Prescription Drugs or Specialty Drugs does not change due to receipt of any Credit by the Corporation. Custodial Care: non-skilled services that are primarily for the purpose of assisting an individual with daily living activities or personal needs (e.g., bathing, dressing and/or eating), which is not specific therapy for any illness or injury. Dependent(s): an individual who is: