Urgent Care Appeal definition

Urgent Care Appeal means an appeal for medical care or treatment with respect to which the application of the time periods for making non-urgent care determinations (i) could seriously jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function; or (ii) in the opinion of the treating health care professional with knowledge of the covered person’s medical condition, would subject the covered person to severe pain that cannot be adequately managed without the care or treatment that is the subject of the appeal. an urgent care appeal shall not be available for any post-service claim or retrospective adverse determination.
Sample 1Sample 2Sample 3

Examples of Urgent Care Appeal in a sentence

  • The Member or the Member’s Health Care Provider requesting the Urgent Care Appeal may contact the Claim Administrator by telephone, fax or other methods that will expedite receipt of the information by the Claim Administrator.

  • The Urgent Care Appeal review shall include the written input and/or presence of a licensed physician or approved licensed psychologist in the same or similar specialty that typically manages or consults on the health care service, condition, performs the procedure, or provides the treatment and who was not previously involved in the matter under review.

  • A Member or a Member’s Health Care Provider may request an Urgent Care Appeal either orally or in writing.

  • The Claim Administrator shall perform an Urgent Care Appeal Review and render a decision within seventy two (72) hours of receipt of the Member’s request.

  • The Member shall be responsible to provide information to the Claim Administrator in an expedited manner to allow the Claim Administrator to conform to the Urgent Care Appeal requirements.

  • If additional information is needed to decide an Urgent Care Appeal, the Claim Administrator will notify the Claimant, the Authorized Representative or the health care provider by phone within 24 hours after the appeal is filed what additional information is needed and assist with the collection of such information.

  • An Appeal that must be reviewed under the expedited Urgent Care Appeal process because the application of non-Urgent Care Appeal timeframes could seriously jeopardize the life or health of the Participant or the Participant’s ability to regain maximum function.

  • An Urgent Care Appeal is also an Appeal involving care that the treating physician deems urgent in nature, or the treating physician determines that a delay in care would subject the Participant to severe pain that could not be adequately managed without the care or treatment that is being requested.

  • In addition to the residential growth, there has been considerable growth in the greenhouse industry resulting in an increase in the total annual water consumption from 1.2 billion gallons per year in 1958 to 4.0 billion gallons in 2011.The treatment plant, situated in the Town of Kingsville on the North Shore of Lake Erie, is a conventional filtration surface water treatment facility with a design capacity of 125 MLD.

  • Expedited (Urgent Care) Appeal: An appeal that must be reviewed under an expedited process because the application of non-expedited appeal time frames could seriously jeopardize a Member's life or health or the Member's ability to regain maximum function.

Related to Urgent Care Appeal

  • Urgent Care Claim means a claim for medical care or treatment where making a non-urgent care decision: (a) could seriously jeopardize the life or health of the claimant or the ability of the claimant to regain maximum function, as determined by an individual acting on behalf of the plan applying the judgment of a prudent layperson who possesses an average knowledge of health and medicine; or (b) in the opinion of a physician with knowledge of the claimant’s medical condition, would subject the claimant to severe pain that cannot be adequately managed without the care.

  • Urgent care request means a claim relating to an admission, availability of care, continued stay or health care service for which the covered person received emergency services but has not been discharged from a facility, or any Pre-Service Claim or concurrent care claim for medical care or treatment for which application of the time periods for making a regular external review determination:

  • Urgent Care means treatment for a condition that is not a threat to life or limb but does require prompt medical attention. Also, the severity of an urgent condition does not necessitate a trip to the hospital emergency room. An Urgent Care facility is a freestanding facility that is not a physician’s office and which provides Urgent Care.

  • URGENT CARE CENTER means a healthcare center either affiliated with a hospital or other institution or independently owned and operated. These centers may also be referred to as walk-in centers.

  • Inpatient care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • PREVENTIVE CARE SERVICES means covered healthcare services performed to prevent the occurrence of disease as defined by the Affordable Care Act (ACA). See Preventive Care and Early Detection Services in Section 3. PRIMARY CARE PROVIDER (PCP) means, for the purpose of this plan, professional providers that are family practitioners, internists, and pediatricians. For the purpose of this plan, gynecologists, obstetricians, nurse practitioners, and physician assistants may be credentialed as PCPs. To find a PCP or check that your provider is a PCP, please use the “Find a Doctor” tool on our website or call Customer Service.

  • Nursing Care Plan means a plan of care developed by a nurse that describes the medical, nursing, psychosocial, and other needs of a child and how those needs shall be met. The Nursing Care Plan includes which tasks shall be taught, assigned, or delegated to the qualified provider or family.

  • Routine patient care costs means Covered Medical Expenses which are typically provided absent a clinical trial and not otherwise excluded under the Policy. Routine patient care costs do not include:

  • Primary care physician or “PCP” means a Plan Provider who has an independent contractor agreement with HPN to assume responsibility for arranging and coordinating the delivery of Covered Services to Members. A Primary Care Physician’s agreement with HPN may terminate. In the event that a Member’s Primary Care Physician’s agreement terminates, the Member will be required to select another Primary Care Physician.

  • Dependent care assistance program means a benefit plan

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.

  • Emergency medical care provider means an individual who has been trained to provide emergency and nonemergency medical care at the first responder, EMT-basic, EMT-intermediate, EMT-paramedic, paramedic specialist or other certification levels recognized by the department before 1984 and who has been issued a certificate by the department.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Child Care Program means a person or business that offers child care.

  • In Patient Care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • psychiatric emergency medical condition means a Mental Disorder that manifests itself by acute symptoms of sufficient severity that it renders the patient as being either of the following:

  • Vocational rehabilitation services means professional services reasonably necessary during or after, or both during and after, medical treatment to enable a disabled injured employee to return to gainful employment as soon as practical. "Vocational rehabilitation services" includes vocational evaluation, retraining and job placement.

  • HMO means any health maintenance organization, managed care organization, any Person doing business as a health maintenance organization or managed care organization, or any Person required to qualify or be licensed as a health maintenance organization or managed care organization under applicable federal or state law (including, without limitation, HMO Regulations).

  • Medical care facility as used in this title, means any institution, place, building or agency, whether

  • Health care decision means any decision regarding the health care of the prospective donor.

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • Intensive Care Unit means an identified section, ward or wing of a hospital which is under the constant supervision of a dedicated medical practitioner(s), and which is specially equipped for the continuous monitoring and treatment of patients who are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the ordinary and other wards.

  • child care element of working tax credit means the element of working tax credit prescribed under section 12 of the Tax Credits Act 2002 (child care element).

  • Preventive Care means certain Preventive Care services.