Urgently Needed Care definition

Urgently Needed Care or “urgent care” means those health care services that are necessary to treat a condition or illness of an individual that if not treated within twenty- four (24) hours presents a serious risk of harm.
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Urgently Needed Care means the care provided to you when you are outside of the LIFE service area and you believe your illness or injury is too severe to postpone treatment until you return to the service area, but your life or function is not in severe jeopardy.
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Urgently Needed Care means Covered Services provided when a Covered Individual is either:
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Examples of Urgently Needed Care in a sentence

  • Emergency Services & Urgently Needed Care LIFE provides access to care 24 hours per day, 7 days per week and 365 days per year.

  • If you have an emergency or have urgent need for care after normal business hours, see Sections 3.fi Emergency Care or 3.2 Urgently Needed Care in this chapter.How do you choose your PCP?When you enroll, you’ll receive a Provider Directory to help you select a PCP.

  • All covered services and supplies, except for Emergency and Urgently Needed Care, for Subscribers and their eligible dependents must be performed by the Physician Group or authorized by them to be performed by another provider.Any covered service or supply may require a Copayment or have a benefit maximum.

  • In most cases, we will not pay for Urgently Needed Care that you get from a Non-Plan Provider while you are in the Plan’s Service Area.

  • We will provide benefits for Urgently Needed Care provided by a Participating or a Non-Participating Provider.

  • In cases involving Urgently Needed Care, we will notify you and your Provider, by telephone, of our decision within 24 hours of the time that the request for concurrent review and prior authorization is requested.

  • Your Physician Group performs or authorizes all care, and you will not have to file claims.There is an exception when you receive covered Emergency Care or Urgently Needed Care from a provider who does not have a contract with Health Net.When cash benefits are due, Health Net will reimburse you for the amount you paid for services or supplies, less any applicable Copayment.

  • However, if you need to file a claim (for example, for Emergency or Urgently Needed Care from a non-Health Net provider), you must do so within one year from the date you receive the services or supplies.

  • See the "Definitions Related to Emergency and Urgently Needed Care" section below for the definition of Urgently Needed Care.

  • Urgently Needed Care is any otherwise covered medical service that a reasonable person with an average knowledge of health and medicine would seek for treatment of an injury, unexpected illness or complication of an existing condition, including pregnancy to prevent the serious deterioration of his or her health, but which does not qualify as Emergency Care, as defined in this section.


More Definitions of Urgently Needed Care

Urgently Needed Care means any otherwise Covered Service necessary to prevent seri- ous deterioration of the health of a Member, resulting from an unforeseen illness, injury, or complication of an existing condition, includ- ing pregnancy, for which treatment cannot be delayed until the Member is able to see his
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Urgently Needed Care means any otherwise Covered Service necessary to prevent seri-
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Urgently Needed Care means MA Covered Services provided when a MA Member is either: (1) temporarily absent from Plan's Medicare Advantage service area and such MA Covered Services are Medically Necessary and immediately required: (a) as a result of an unforeseen illness, injury, or condition; and (b) it was not reasonable, given the circumstances, to obtain the services through Plan's Medicare Advantage Network; or (2) under unusual and extraordinary circumstances, the MA Member is in the service area but Plan's Network is temporarily unavailable or inaccessible and such MA Covered Services are Medically Necessary and immediately required: (a) as a result of an unforeseen illness, injury, or condition; and (b) it was not reasonable, given the circumstances, to obtain the services through Plan's Medicare Advantage Network.
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Urgently Needed Care is when you need medical help for an unforeseen illness, injury, or condition, but your health is not in serious danger and you are generally outside of the service area. How to get urgently needed care If, while temporarily outside the Plan’s service area, you require urgently needed care, then you may get this care from any provider.
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Urgently Needed Care means any otherwise Covered Service necessary to prevent serious deterioration of the health of a Member, resulting from an unforeseen illness, injury, or complication of an existing condition, including pregnancy, for which treatment cannot be delayed until the Member is able to see his or her PCP. This includes maternity services necessary to prevent serious deterioration of the health of the Member or the Member’s
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Urgently Needed Care means MA Covered Services provided when a MA Member is either: (1) temporarily absent from Plan's Medicare Advantage service area and such MA Covered Services are Medically Necessary and immediately required: (a) as a result of an unforeseen illness, injury, or condition; and (b) it was not reasonable, given the circumstances, to obtain the services through Plan's Medicare Advantage Network; or
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Related to Urgently Needed Care

  • Urgently Needed Services means Covered Services needed to prevent a serious deterioration in a Member’s health. While not as immediate as Emergency Services, these services cannot be delayed until the Member can see a Plan Provider.

  • 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.

  • Medically necessary care means care that is (1) appropriate and consistent with and essential for the prevention, diagnosis, or treatment of a Patient’s condition; (2) the most appropriate supply or level of service for the Patient’s condition that can be provided safely; (3) not provided primarily

  • Emergency medical care means such medical procedures as:

  • Mental health therapist means the same as that term is defined in Section 58-60-102.

  • Adult foster care means room and board, supervision, and special services to an adult who has a

  • Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.

  • Child care means continuous care and supervision of five or more qualifying children that is:

  • Emergency medical services or “EMS” means an integrated medical care delivery system to provide emergency and nonemergency medical care at the scene or during out-of-hospital patient transportation in an ambulance.

  • Mental health services means interventions designed to provide the maximum reduction of mental disability and restoration or maintenance of functioning consistent with the requirements for learning, development and enhanced self-sufficiency. Services shall include:

  • Primary care giver" means a person who assumes the principal role of providing care and attention to a child.

  • 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.

  • Centers for Medicare and Medicaid Services or “CMS” means the federal office under the Secretary of the United States Department of Health and Human Services, responsible for the Medicare and Medicaid programs.

  • Emergency care means management for an illness or injury which results in symptoms which occur suddenly and unexpectedly, and requires immediate care by a medical practitioner to prevent death or serious long term impairment of the insured person’s health.

  • 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.

  • 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.

  • Respiratory care means the practice of the allied health profession responsible for the direct and

  • Primary care-giver means a person who assumes the principal role of providing care and attention to a child.

  • Emergency Medical Technician (EMT means: an individual licensed with cognitive knowledge and a scope of practice that corresponds to that level in the National EMS Education Standards and National EMS Scope of Practice Model.

  • Medically Necessary Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:

  • Skilled Nursing Care means services requiring the skill, training or supervision of licensed nursing personnel.

  • Hospice Care means a coordinated program of active professional

  • Emergency medical technician means a person who is either an EMT-I, EMT-II, or EMT-P (paramedic), and possesses a valid certificate or license in accordance with the standards of Division 2.5 (commencing with Section 1797) of the Health and Safety Code.

  • Mental health facility means a mental health facility as defined by the Inpatient Mental Health Treatment of Children Act;

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

  • Acute care means preventive care, primary care, and other medical care provided under the direction of a physician for a condition having a relatively short duration.