Emergency and Urgent Care Services Sample Clauses

Emergency and Urgent Care Services. (1) Contractor shall establish written policies and procedures and monitoring systems that provide for Emergency Services including post-stabilization care services, and Urgent Services for all Members on a 24-hour, 7-day-a-week basis consistent with OAR 410- 141-3140 and 42 CFR 438.114. The emergency response system must include the necessary array of services to respond to mental health crises, that may include crisis hotline, mobile crisis team, walk-in/drop- off crisis center, crisis apartment/respite and short-term stabilization unit capabilities. Contractor’s policies and procedures shall include an emergency response system that provides an immediate, initial and/or limited duration response for potential mental health emergency situations or emergency situations that may include mental health conditions, which consist of: screening to determine the nature of the situation and the person’s immediate need for Covered Services; capacity to conduct the elements of a Mental Health Assessment that are needed to determine the interventions necessary to begin stabilizing the crisis situation; development of a written initial services plan at the conclusion of the Mental Health Assessment; provision of Covered Services and Outreach needed to address the urgent or emergency situation; and linkage with the public sector crisis services, such as pre-commitment.
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Emergency and Urgent Care Services. Members experiencing an Emergency Medical Condition, may call 911 (where available) or go to the nearest emergency department. Emergency Services do not need prior authorization. Emergency Services for Emergency Medical Conditions are covered when provided by Physicians and medical practitioners other than Physicians anywhere in the world, as long as the Services would have been covered under this section S (subject to the Exclusions and Limitations section of this Service Agreement) if received from Physicians. Emergency Services are available from Health Plan emergency departments 24 hours a day, seven days a week.
Sample 1
Emergency and Urgent Care Services. An emergency can be any medical or behavioral condition that would lead you to believe that the condition, sickness, or injury is of such a nature that failure to obtain immediate medical care could result in placing your health in serious jeopardy. You are not required to get prior approval from MetroPlus Managed Long Term Care to be treated for emergency medical conditions. If you need Emergency Services, call 911 right away or visit the nearest hospital or emergency room. Wherever you have an emergency or urgent situation, get the care first, and then contact your Care Manager as soon as you are able to. It’s important that you, a family member or a friend call your Care Manager as soon as possible at 1- 855-355-MLTC (6582) after an emergency or urgent care service. TTY users can call 711 Your Care Manager can reschedule any planned services you might miss during that time, and start to make any needed changes to your Care Plan. He or she will help you avoid any unnecessary gaps in the services you might need. If you have Medicare and/or Medicare supplemental coverage and benefits and/or Medicaid, your emergency care will be covered by them and by your MLTC plan. Non-Covered Services You can still receive the following services listed below. Medicare and/or Medicaid may cover these services on a fee-for-service basis from a provider who accepts Medicare and/or Medicaid. These Are Some Examples of Non-Covered Services:  Inpatient and Outpatient Hospital ServicesPrimary Care and Specialty Doctor Services  Outpatient Clinic ServicesLaboratory Services  X-Ray and other Radiology ServicesChiropractic ServicesChronic Renal DialysisEmergency Transportation  Emergency Room (ER) visits  Non Medical TransportationCosmetic surgery if not medically needed  Personal and Comfort items  Infertility Treatment  Services of providers that are not part of the plan (unless MetroPlus MLTC refers you to that provider)  Mental Health and Substance Abuse ServicesPrescription and Non-Prescription DrugsAssisted Living ProgramFamily Planning Services  Office of Mental Retardation and Developmental Disabilities (OMRDD) Services Our Network Providers Members are required to use our Network Providers for all covered services. Your Care Manager will also coordinate any services you may require that are not covered by MetroPlus Managed Long Term Care. Your Care Manager will work with your doctor and other providers involved in your care to make thi...
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Emergency and Urgent Care Services 
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Related to Emergency and Urgent Care Services

  • Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

  • Office Visits (other than Preventive Care Services) This plan covers office and clinic visits to diagnose or treat a sickness or injury. Office visit copayments differ depending on the type of provider you see. This plan covers physician visits in your home if you have an injury or illness that: • confines you to your home; or • requires special transportation; and • because of this injury or illness, you are physically unable to travel to the provider’s

  • Special Services Should the Trust have occasion to request the Adviser to perform services not herein contemplated or to request the Adviser to arrange for the services of others, the Adviser will act for the Trust on behalf of the Fund upon request to the best of its ability, with compensation for the Adviser's services to be agreed upon with respect to each such occasion as it arises.

  • Training Services Training Services may include pre-packaged training Products, and/or the development or customization of training programs as requested, including Live Training, Computer Based/Multi-Media Training which encompasses Internet-Delivered Training, and/or Video Based Training.

  • Educational Services Any service or supply for education, training or retraining services or testing including: special education, remedial education; cognitive remediation; wilderness/outdoor treatment, therapy or adventure programs (whether or not the program is part of a Residential Treatment facility or otherwise licensed institution); job training or job hardening programs; educational services and schooling or any such related or similar program including therapeutic programs within a school setting.

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • Vision Care Services For purposes of coordination of benefits, vision care services covered under other plans are not considered an allowable expense, as defined in the Coordination of Benefits and Subrogation in Section 7.

  • EFT SERVICES If approved, you may conduct any one (1) or more of the EFT services offered by the Credit Union.

  • COVERED HEALTHCARE SERVICES This section describes covered healthcare services. This plan covers services only if they meet all of the following requirements: • Listed as a covered healthcare service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered healthcare service under this plan. • Medically necessary, consistent with our medical policies and related guidelines at the time the services are provided. • Not listed in Exclusions Section. • Received while a member is enrolled in the plan. • Consistent with applicable state or federal law. We review medical necessity in accordance with our medical policies and related guidelines. Our medical policies can be found on our website. Our medical policies are written to help administer benefits for the purpose of claims payment. They are made available to you for informational purposes and are subject to change. Medical policies are not meant to be used as a guide for your medical treatment. Your medical treatment remains a decision made by you with your physician. If you have questions about our medical policies, please call Customer Service. When a new service or drug becomes available, when possible, we will review it within six (6) months of one of the events described below to determine whether the new service or drug will be covered: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final Food and Drug Administration (FDA) approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). During the review period, new services and drugs are not covered. For all covered healthcare services, please see the Summary of Medical Benefits and the Summary of Pharmacy Benefits to determine the amount that you pay and any benefit limits.

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