Common use of Emergency Health Care Services Clause in Contracts

Emergency Health Care Services. Benefits for treatment of Emergency medical conditions and Emergency screening and Stabilization services without Prior Authorization for conditions that reasonably appear to a prudent layperson to constitute an Emergency medical condition based upon the patient’s presenting symptoms and conditions. Benefits for Emergency Care include facility costs and Physician services, and supplies and Prescription Drugs charged by that facility. Whenever You are admitted as an Inpatient directly from a Hospital emergency room, the Emergency Room Services Copay/Coinsurance for that Emergency Room visit will be waived. For an Inpatient admission following Emergency Care, Precertification is not required. However, Your Physician or the Inpatient facility must seek authorization for your admission within 48 hours or as soon as possible within a reasonable period of time. When We are contacted, Your Provider will be notified whether the Inpatient setting is appropriate and considered Medically Necessary.If Prior Authorization is not obtained within 48 hours of your admission You may be financially responsible for Your Inpatient care. Care and treatment provided once You are Stabilized is no longer considered Emergency Care. Continuation of care from a Non-Participating Provider beyond that needed to evaluate or Stabilize Your condition in an Emergency may be Covered if We authorize the continuation of care and it is Medically Necessary. Transfer to a Participating Provider will be made available to persons receiving post-stabilization care in a Non-Participating Provider facility.