Referred Services. (1) A PHO or Contracted Provider may, in the course of an annual health check, refer an Eligible Person to the following Referred Services, if it is appropriate to do so:
Referred Services. Except as described in the Exclusions and Limitations section of this Rider, the Certificate, any amendments and/or riders are hereby revised to remove the requirement that a Member must obtain a Referral from their PCP prior to accessing Covered Benefits from Participating Providers. Under this provision, a Member may directly access Participating Specialists, ancillary Providers and facilities for Covered Benefits without a PCP Referral, subject to the terms and conditions of the Certificate and any cost-sharing requirements set forth in the Schedule of Benefits. Participating Providers will be responsible for obtaining pre-authorization of services from HMO. Except as described in this Rider, the Covered Benefits section and the Exclusions and Limitations section of the Certificate remain unchanged and the ability of a Member to directly access Participating Providers does not alter any other provisions of the Certificate. Except for Emergency Services and out- of-area Urgent Care services, a Member must access Covered Benefits from Participating Providers. Services rendered by non-Participating Providers will not be covered in non-emergent and non-urgent situations unless HMO has pre-authorized the use of such non-Participating Provider. The Infertility Services Benefit provision of the Covered Benefits section of the Certificate is amended to include the following provision: • Infertility Program – A Member or their Participating Physician may contact the Infertility case management unit to apply for eligibility. A Member who is eligible for the program may be subject to case management, have access to a select network of Participating Providers and will be required to utilize Participating Providers from this select network to receive Covered Benefits. The Exclusions and Limitations section of the Certificate is amended to delete the following exclusion: • Unauthorized services, including any service obtained by or on behalf of a Member without a prior written Referral issued by the Member’s PCP or certified by HMO. This exclusion does not apply in a Medical Emergency or in an Urgent Care situation or when it is a direct access benefit. The Exclusions and Limitations section of the Certificate is amended to include the following limitations: • Upon pre-authorization, other treatment plans may be subject to case management and a Member may be directed to specific Participating Providers for Covered Benefits including, but not limited to transplants an...
Referred Services. A PHO or Contracted Provider may, in the course of an annual health check, refer an Eligible Person to the following Referred Services, if it is appropriate to do so: serum dioxin testing as set out in clause 6; foetal neural tube defect screening and genetic counselling as set out in clause 7; lifestyle improvement services, including smoking cessation, green prescriptions, and dietary information and advice; and mental health services for mild to moderate mental health conditions Serum dioxin test An Eligible Person may be referred for a serum dioxin test if: the Eligible Person has not previously had a serum dioxin test; the Eligible Person has been fully informed about the serum dioxin test at a consultation with his or her nominated General Practitioner, including the limitations and benefits of the serum dioxin test, the testing procedure, and the results are fully explained; the Eligible Person has been referred to a mental health counsellor to identify and address any concerns, and the mental health counsellor has referred the Eligible Person back to the General Practitioner for consideration for serum dioxin testing; the Eligible Person’s General Practitioner is satisfied that the serum dioxin test is not an unnecessary risk to the person and will assist with improving the person’s wellbeing; and the Eligible Person’s General Practitioner has, on behalf of the person, applied to the Ministry for the person to be referred for a serum dioxin test, and received confirmation from the Ministry that the application has been approved. If the Ministry approves an application, the Ministry will arrange a laboratory appointment and serum analysis. Foetal neural tube defect screening and genetic counselling The following persons may be referred for a foetal neural defect screen or genetic counselling or both as part of an annual health check: an Eligible Person: a pregnant woman if the biological father of the unborn child is an Eligible Person (whether or not the pregnant woman is an Eligible Person); and a child of an Eligible Person (whether or not the child is an Eligible Person). A person can be referred for foetal neural defect screening only by a General Practitioner, registered midwife, obstetrician, or family planning Practitioner. A person can be referred for genetic counselling only by a General Practitioner.
Referred Services. For purposes of this Section, “referral” shall mean the act by a Provider providing services at a Health Center of identifying another health care provider and communicating information or a recommendation to a patient about that provider, as distinguished from a Provider exercising Provider’s professional judgment with respect to the diagnosis or treatment of a patient. Providers providing services at the Health Center shall exercise their professional judgment when referring patients for healthcare services. Neither LGMG nor the District will interfere with the professional judgment of the Providers at the Health Center in making such referrals. The District acknowledges and agrees that LGMG will have no responsibility or liability with respect to services provided by such healthcare providers. Notwithstanding the foregoing, LGMG agrees that, with respect to clinical laboratory specimens drawn at the Health Center for which testing is required by an off-site clinical laboratory, LGMG shall send such specimens to a clinical laboratory that participates in the District’s network unless referral to another clinical laboratory is preapproved by the District in writing.
Referred Services. For purposes of this Section, “referral” shall mean the act by a Provider providing services at a Health Center of identifying another health care provider and communicating information or a recommendation to a patient about that provider, as distinguished from a Provider exercising Provider’s professional judgment with respect to the diagnosis or treatment of a patient. Providers providing services at the Health Centers shall exercise their professional judgment when referring patients for healthcare services. Neither LGMG nor the Employer will interfere with the professional judgment of the Providers at the Health Centers in making such referrals. The Employer acknowledges and agrees that LGMG will have no responsibility or liability with respect to services provided by such healthcare providers.
Referred Services. If you are referred to another medical provider for specialized care, please be advised that such medical provider may have financial policies that differ from ours. Billing for medical services rendered by referred physicians, or labs (such as for a second pathology opinion) will be billed and handled by that provider. They may not be contracted with your insurance. The labs and Pathologists to whom we refer provide us trusted and expedient results.
