Common use of Observation Services Clause in Contracts

Observation Services. Observation Services are Outpatient services provided by a Hospital and a Provider on the Hospital’s premises. These services may include the use of a bed and monitoring by a Hospital’s nursing staff that are reasonable and necessary to evaluate Your Condition, determine the need for a possible admission to the Hospital, or when rapid improvement of the Your Condition is expected. When a Hospital places You under Outpatient Observation, it is based upon the Provider’s written order. To move from Observation to an Inpatient admission, Our level of care criteria must be met. The length of time spent in the Hospital is not the only factor determining Observation instead of an Inpatient stay. Medical criteria will also be considered. All Accidental Injury (trauma), Urgent Care, Emergency Care Services, and Observation Services whether provide within or outside of the Plan’s Service Area are subject to the Limitations listed in the Limitations Section and the Exclusions listed in the Exclusions Section. Acquired Brain Injury The Plan covers treatment of an Acquired Brain Injury on the same basis as treatment for any other physical condition. Cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy, and rehabilitation; neurobehavioral, neuropsychological, neurophysiological and psychophysiological testing and treatment; neuro feedback and remediation therapy, post-acute transition and reintegration services, or other treatment services are covered if such services are Medically Necessary as a result of and related to an Acquired Brain Injury. Ambulance Services The Plan covers the following types of Ambulance Services: (1) Emergency Ambulance Services,