Emergency Care Services. If you experience a medical emergency while traveling outside our service area, go to the nearest emergency or urgent care facility. When you receive Out-of-Area covered healthcare services outside our service area and the claim is processed through the BlueCard Program, the amount you pay for the Out-of-Area Covered healthcare services, if not a flat dollar copayment, is calculated based on the lower of: • the billed charges for your Out-of-Area covered healthcare services; or • the negotiated price that the Host Blue makes available to us. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to your healthcare provider. Sometimes, it is an estimated price that takes into account special arrangements with your 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 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 have used for your claim because they will not be applied after a claim has already been paid. Negotiated (non–BlueCard Program) Arrangements With respect to one or more Host Blues, in certain instances, instead of using the BlueCard Program, we may process your claims for covered healthcare services through Negotiated Arrangements for National Accounts. The amount you pay for covered healthcare services under this arrangement will be calculated based on the negotiated price (refer to the description of negotiated price in the BlueCard® Program section above) made available to us by the Host Blue.
Emergency Care Services. The Policy Board shall review, approve and periodically make suggestions for improving (i) the organization and delivery of emergency Dental Care by Provider, and (ii) the process and guidelines for ensuring an appropriate response by Provider to dental and in-Clinic medical emergencies as they may occur from time to time.
Emergency Care Services. In the event of an emergency, the Contractor shall take the inmate to the nearest hospital able to provide emergency care. If an inmate should need to be transferred by air, CONTRACTOR shall use appropriate aviation assets. All ambulances utilized shall be equipped with life support systems and shall be operated by personnel trained in life support and currently certified by the State. CONTRACTOR shall obtain documentation of State certification and keep it on file at the Facility. CONTRACTOR shall be responsible for the cost of all emergency air ambulance or land ambulance transportation. The following service requirements shall be met to ensure that qualified emergency treatment is provided:
Emergency Care Services. When Emergency Care Services are received from a UPMC Provider that is an Out-of- Network Provider under this Agreement, benefits are provided as set forth in Subsection F. EMERGENCY CARE SERVICES of SECTION DB - DESCRIPTION OF BENEFITS of this Agreement and also includes such other Services and supplies necessary to continue to treat the Member, including any resulting Inpatient admission, through the period of discharge. Covered Services shall be available at the Enhanced Value level of benefits.
Emergency Care Services. Services and supplies for the Outpatient emergency treatment of bodily injuries resulting from an accident or a medical condition, as described in the EMERGENCY CARE SERVICES Definition of SECTION DE - DEFINITIONS of this Agreement, including a medical screening examination and ancillary services necessary to evaluate such injury or emergency medical condition, and such further medical examination and treatment as required to stabilize the patient. Transportation and related emergency services provided by an Ambulance Service shall constitute Emergency Ambulance Services if the injury or the condition satisfies the criteria as described in the EMERGENCY CARE SERVICES Definition of SECTION DE - DEFINITIONS of this Agreement.
Emergency Care Services. A written, student-specific emergency plan shall be in place for each medically fragile student. All staff involved with the student should have a copy of the plan. Each staff member involved with the student shall be appropriately trained in all relevant details of the emergency plan.
Emergency Care Services the treatment:
Emergency Care Services. Coverage is provided for the treatment of bodily injuries resulting from an accident or the treatment of a medical condition with acute symptoms of sufficient severity or severe pain for which care is sought as soon as possible after the medical condition becomes evident to the member or the member’s parent or guardian and which the absence of immediate medical attention could reasonably result in: a) placing the member’s health in jeopardy, b) causing serious impairment to bodily functions, c) causing serious dysfunction of any bodily organ or part or d) causing other serious medical consequences. Treatment for an occupational injury for which benefits are provided under any Workers’ Compensation Law or any similar Occupational Disease Law is not covered. Transportation and related emergency services provided by an ambulance service shall constitute emergency care if the injury or the condition satisfies the criteria above. In the event that the member requires Emergency Care Services, benefits will be provided at the network services benefit levels. The member will not be responsible for any difference between the Plan payment and the provider’s charge.
Emergency Care Services. If You are admitted as an Inpatient to a Hospital, You or Your Practitioner needs to notify Us as soon as possible so we can review Your Hospital stay. We will approve or deny coverage of post stabilization care as requested by Your treating Practitioner within the appropriate time, depending on the services requested and Your condition, but in no more one hour from the time of the request. We will not deny a claim for Emergency Care Services when You are sent to the emergency room by Your PCP or by Our representative. If Your Emergency Care Services results in a hospitalization directly from the emergency room, You are responsible for paying the Inpatient Hospital Cost Sharing amounts rather than the emergency room visit Copayment. Read to Your Schedule of Benefits for the Cost Sharing amount. For Emergency Care Services received from a Non-Participating Provider and/or outside of Texas, You may seek Emergency Care Services from the nearest appropriate facility where Emergency Care Services can be rendered. Non-emergency follow-up care received outside of Texas for Your convenience or preference is not a Covered Benefit. Follow-up care from a Non-Participating Provider needs Preauthorization. You must pay for charges that We do not authorize. Whether You require hospitalization or not, You should notify Your PCP or Physician within 48 hours, or as soon as reasonably possible, of any emergency medical treatment so he can recommend the continuation of any necessary medical services.
Emergency Care Services. 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/CCHCS patients and/or DJJ youth suffering from situational crisis or acute episodes of mental illness, in accordance with California Code of Regulations, Title 15.
