Definition of Emergency Services. Emergency services" means those health care services that are provided in a hospital emergency facility after the sudden onset of a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson, who possesses an average knowledge of health and medicine, to result in:
Definition of Emergency Services. An Emergency Medical Condition is a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: Serious jeopardy to the health of the individual; Serious impairment to bodily functions; or Serious dysfunction of any bodily organ or part. You will know that your problem requires Emergency Care by asking yourself the following questions:
Definition of Emergency Services. For the entirety of this section, emergency, stabilization, and/or post-stabilization services only pertain to those that are related to behavioral health(i.e., the encounter submissions have a primary diagnosis code indicating a behavioral health diagnosis). See Article IV, section B(2)(c) for more details.
Definition of Emergency Services. An Emergency Medical Condition is a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: Serious jeopardy to the health of the individual; Serious impairment to bodily functions; or Serious dysfunction of any bodily organ or part. You will know that your problem requires Emergency Care by asking yourself the following questions: Do I need help on-the-spot because of an injury or sudden illness? Does the time required to reach PACE CNY Staff mean I could risk permanent damage to my health? Could I die as a result? You are not required to get Prior Authorization for treatment of Emergency Medical Conditions that you believe meet the above criteria. PACE CNY will cover Emergency Services. In the event of an Emergency Medical Condition, go to the closest emergency room, or call 911 for assistance. Tell the hospital and/or ambulance company that you are a PACE CNY participant. It is important to notify PACE CNY of an Emergency Medical Condition when outside of the PACE CNY Service Area or when you have received emergency services from a non-PACE CNY provider. By calling PACE CNY we can provide the emergency room and/or hospital with critical information regarding your health care needs. PACE CNY will make discharge arrangements and coordinate any other necessary health care services during and immediately following your emergency room visit and/or hospitalization. Please call PACE CNY at the number located on your membership card (315 452-5800) as soon as reasonably possible. PACE CNY on-call staff is available 24 hours a day at (000) 000-0000 or outside of the local area 0-000-000-0000 to address any participant questions about accessing emergency services and to respond to requests for authorization of urgently needed services or post-stabilization care services following emergency services. Following a medical emergency, PACE CNY will also pay for care you need before your condition is stable enough to return to the care of the PACE CNY team. This is Post Stabilization Care and will be covered as long as PACE CNY has been notified of the situation and has given prior authorization for service provision from a non-PACE CNY provider. However, if PACE CNY does not respond to a request for approval within one hour, or cannot be contacted, the services wil...
