Urgently Needed Services definition
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.
Urgently Needed Services means covered services that are not Emergency Services as defined in this section, provided when an Enrollee is temporarily absent from the Contractor’s service area when the services are medically necessary and immediately required: (1) as a result of an unforeseen illness, injury or condition; and (2) it was not reasonable given the circumstances to obtain the services through the Contractor’s Participating Providers. Such services are sometimes referred to as “urgent care.”
Urgently Needed Services means Covered Services that are not emergency services as defined in 42 CFR §422.113 provided when a Member is temporarily absent from the Medicare Advantage Program Plan’s service area (or if applicable, continuation area) or, under unusual and extraordinary circumstances, Covered Services provided when the Member is in the service or continuation area but the Network is temporarily unavailable or inaccessible and when the Covered Services are Medically Necessary and immediately required as a result of an unforeseen illness, injury, or condition; and it was not reasonable, given the circumstances, to obtain the Covered Services through the Medicare Advantage Plan Network. “Stabilized Condition” means a condition whereby the physician treating the Member must decide when the Member may be considered stabilized for transfer or discharge, and that decision is binding on the Plan.
Examples of Urgently Needed Services in a sentence
In addition, benefits for such services are not payable unless the Covered Services are determined to be Urgently Needed Services or Emergency Services as defined in this AOC.
Covered Services received while outside the HPN Service Area are limited to Emergency Services and Urgently Needed Services when care is required immediately and unexpectedly.
Out-of-Area Emergency and Urgently Needed Services are reimbursed at *** of allowed amount, and the remaining *** shall be charged against the Shared Risk Budget.
This section does not apply to Emergency Services or Urgently Needed Services as defined in this AOC, or other Covered Services provided by a Non-Plan Provider which have otherwise been approved by HPN’s Managed Care Program.
Benefits for Emergency or Urgently Needed Services received from Non-Plan Providers are limited to the Eligible Medical Expenses for care required before the Member can safely receive services from his PCP.
More Definitions of Urgently Needed Services
Urgently Needed Services means covered services that are not Emergency Services as defined in this Section, provided when an Enrollee is temporarily absent from the Contractor's service area, when the services are medically necessary and immediately required:
Urgently Needed Services means Covered Services needed to prevent a serious deterioration in an Insured’s health. While not as immediate as Emergency Services, these services cannot be delayed until the Insured can see a Plan Provider.
Urgently Needed Services means Covered Services (i) which are provided when a Member is temporarily absent from the Service Area; (ii) which are immediately required as a result of an unforeseen illness, injury, or condition and (iii) with respect to which it is not reasonable, given the circumstances, to obtain the services from a Participating Provider in the Service Area.
Section 4.1 CREDENTIALING REQUIREMENTS is hereby superseded and replaced as follows:
Urgently Needed Services will mean medical services received outside of the Service Area which are, in the judgment of a prudent layperson, required without delay in order to prevent serious deterioration of Enrollee’s health as a result of an illness or injury.
Urgently Needed Services means services for a non-life-threatening condition that requires care by a provider within twenty-four (24) hours.
Urgently Needed Services means Covered Services that are not emergency services as defined in 42 C.F.R. §422.113 provided when a Member/Enrollee is temporarily absent from the Medicare Advantage Program Plan’s service area (or if applicable, continuation area) or, under unusual and extraordinary circumstances, Covered Services provided when the Member is in the service or continuation area but the Network is temporarily unavailable or inaccessible and when the Covered Services are Medically Necessary and immediately required as a result of an unforeseen illness, injury, or condition; and it was not reasonable, given the circumstances, to obtain the Covered Services through the Medicare Advantage Plan Network. “Stabilized Condition” means a condition whereby the physician treating the Member must decide when the Member may be considered stabilized for transfer or discharge, and that decision is binding on the Plan.
Urgently Needed Services means Covered Services needed to prevent a serious deterioration in an Insured’s health.