Emergency care services means those services identified in 18 Del.C. §§3349(d) and 3565(d) performed at any time during the Duration of an Emergency Medical Condition, including any covered service providing for the transportation of a patient to a hospital emergency facility for an emergency medical condition including air and sea ambulances so long as medical necessity criteria are met.
Emergency care services. If a Member experiences a Medical Emergency while traveling outside Keystone’s Approved Service Area, medical treatment should be sought from the nearest appropriate Facility Provider. Whenever Members access covered healthcare services outside Keystone’s Approved Service Area and the claim is processed through the BlueCard Program, the amount Members pay for covered healthcare services, if not a flat dollar copayment, is calculated based on the lower of: The billed covered charges for their covered services; or The negotiated price that the Host Blue makes available to Keystone. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to the Member’s healthcare provider. Sometimes, it is an estimated price that takes into account special arrangements with the Member’s healthcare provider or provider group that may include types of settlements, incentive payments, and/or other credits or charges. Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of healthcare providers after taking into account the same types of transactions as with an estimated price. Estimated pricing and average pricing, going forward, also take into account adjustments to correct for over - or underestimation of modifications of past pricing for the types of transaction modifications noted above. However, such adjustments will not affect the price Keystone uses for Members’ claims because they will not be applied retroactively to claims already paid. Federal law or the laws in a small number of states may require the Host Blue to add a surcharge to this calculation. If federal law or any state laws mandate other liability calculation methods, including a surcharge, Keystone would then calculate Member liability for any covered healthcare services according to applicable law.
Emergency care services. If you experience a Medical Emergency while traveling outside our Service Area, go to the nearest Emergency or urgent care facility. Whenever You receive Covered Services and the claim is processed through the BlueCard Program, the amount you pay for such services, if not a flat dollar Copayment, is calculated based on the lower of: S the billed covered charges for the Covered Services, or S the negotiated price that the Host Blue makes available to us. Often, this “negotiated price” is a simple discount that reflects the actual price the Host Blue pays to your healthcare Provider. Sometimes, it is an estimated price that takes into account special arrangements with an individual Provider or a provider group that may include settlements, incentive payments, and/or other credit or charges. Occasionally, it may be an average price based on a discount that results in expected average savings for similar types of healthcare Providers after taking into account the same types of transactions as with an estimated price. Estimated pricing and average pricing also take into account adjustments to correct for over- or underestimation of past pricing of claims, as noted above. However, such adjustments will not affect the price we use for your claim because they will not be applied after a claim has already been paid. Federal or state laws or regulations may require a surcharge, tax or other fee that applies to insured accounts. If applicable, Blue Cross and Blue Shield of Texas will include any such surcharge, tax or other fee as part of the claim charge passed on to you. If federal law or any state laws mandate other liability calculation methods, including a surcharge, HMO would then calculate your liability for any Covered Services according to the applicable law in effect when care is received.
Examples of Emergency care services in a sentence
Emergency care services or urgent care services furnished to a Medicare beneficiary with whom the physician or practitioner has previously entered into a private contract (that is, entered into before the onset of the emergency medical condition or urgent medical condition), are furnished under the terms of the private contract.
The emergency room Copayment will not apply.Notwithstanding anything in this benefit booklet to the contrary, the method used to determine the Eligible Charge for Emergency care services will be equal to the greatest of the following three possible amounts:1.
Emergency care services provided in a hospital or freestanding emergency room; and2.
The emergency room Copayment will not apply.Notwithstanding anything in this benefit booklet to the contrary, the method used to determine the Maximum Allowance for Emergency care services will be equal to the greatest of the following three possible amounts:1.
Emergency care services are determined as Medically Necessary in accordance with Anthem Blue Cross Medical Policy.Benefits are also provided for emergency maternity admissions if due to unexpected “premature” delivery.
More Definitions of Emergency care services
Emergency care services means services for an emergency medical condition as defined in 31A-22-627(3).
Emergency care services means the immediate care or treatment necessary to prevent death, severe or permanent disability or to alleviate severe pain, including medically necessary crisis intervention for CDCR Patient-Inmates/DJJ Youth suffering from situational crisis or acute episodes of mental illness, in accordance with CCR, Title 15.
Emergency care services means those services identified in 18 Del.C. §§3349(c) and 3565(c) including:
Emergency care services means serv- ices furnished to an individual for treatment of an ‘‘emergency medical condition’’ as that term is defined in § 422.2 of this chapter. Legal representative means one or more individuals who, as determined by applicable State law, has the legal authority to enter into the contract with the physician or practitioner on behalf of the beneficiary. Opt-out means the status of meeting the conditions specified in § 405.410. Opt-out period means the 2-year pe- riod beginning on the effective date of the affidavit as specified by § 405.410(c)(1) or § 405.410(c)(2), as appli- cable. Participating physician means a ‘‘phy- sician’’ as defined in this section who has signed an agreement to participate in Part B of Medicare. Physician means a doctor of medi- cine; doctor of osteopathy; doctor of dental surgery or of dental medicine; doctor of podiatric medicine; or doctor of optometry who is legally authorized to practice medicine, osteopathy, den- tal surgery, dental medicine, podiatric medicine, or optometry by the State in which he performs such function and who is acting within the scope of his li- cense when he performs such functions. Practitioner means a physician assist- ant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse midwife, clinical psychologist, or clinical social worker, who is currently legally au- thorized to practice in that capacity by each State in which he or she furnishes services to patients or clients.
Emergency care services means those services identified in 18 Del.C. §§3349(c) and 3565(c) including: a provider who also provides health care services that aren't emergency care services.
Emergency care services means medical services provided for an emergency medical condition.
Emergency care services means health care items or services furnished or required to evaluate and treat an Emergency Medical Condition. Such emergency care services must be provided by or ordered by a licensed health care provider in a Hospital’s emergency room.