Second Medical Opinions Sample Clauses

Second Medical Opinions. Members are entitled to a second medical opinion when disputing the appropriateness or necessity of a surgical procedure, or when subject to a serious injury or illness.
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Second Medical Opinions. AvMed may limit second medical opinions in connection with a particular diagnosis or treatment to three per Calendar Year, if AvMed deems additional opinions to be an unreasonable over-utilization by the Member.
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Second Medical Opinions. The County must have written policies for procedures guaranteeing each member’s right to receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand for providing members the opportunity to have a second opinion from a qualified network provider subject to referral procedures approved by the Department. If an appropriately qualified provider is not available within the network, the County must authorize and reimburse for a second opinion outside the network at no charge to the member, excluding allowable copayments.
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Second Medical Opinions. An enrollee or participating provider, who is treating an enrollee, may request a second medical opinion by an appropriately qualified health care professional. Reasons for a second opinion to be provided or authorized shall include, but are not limited to, the following: • Reasonableness or necessity of recommended treatment is questioned. • Diagnosis or treatment plan is questioned. • Clinical indications are not clear or are complex and confusing. • Treatment plan in progress is not improving the condition of the enrollee within an appropriate period of time given the diagnosis and plan of care. Xxxxxx'x decision to xxxxx or deny the request for a second medical opinion will be delivered to the individual who requested the second medical opinion. If the enrollee faces an imminent and serious threat to his or her mental health, the second opinion shall be rendered within (72) hours after the receipt of the request. If the request for a second opinion is approved, the enrollee will be responsible for all applicable copayments. If the request for a second opinion is denied, the enrollee will be notified in writing of the reasons for the denial and shall be informed of the right to file a grievance with the Plan. The request for a second medical opinion can be made by calling Xxxxxx at 1-800-321- 2843, or by writing to: Xxxxxx Professional Counseling Centers, Care Management Department, PO Box 8011, Canoga Park, CA 91309.
Sample 1
Second Medical Opinions. The County PIHP must have written policies for procedures guaranteeing each member’s right to receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand for providing members the opportunity to have a second opinion from a qualified network provider subject to referral procedures approved by the Department. If an appropriately qualified provider is not available within the network, the County PIHP must authorize and reimburse for a second opinion outside the network at no charge to the member, excluding allowable copayments.
Sample 1

Related to Second Medical Opinions

  • Second Opinions The Member may access a second opinion from a Network Provider regarding a medical diagnosis or treatment plan. The Member may request Preauthorization or may visit a KFHPWA-designated Specialist for a second opinion. When requested or indicated, second opinions are provided by Network Providers and are covered with Preauthorization, or when obtained from a KFHPWA-designated Specialist. Coverage is determined by the Member's EOC; therefore, coverage for the second opinion does not imply that the services or treatments recommended will be covered. Preauthorization for a second opinion does not imply that KFHPWA will authorize the Member to return to the physician providing the second opinion for any additional treatment. Services, drugs and devices prescribed or recommended as a result of the consultation are not covered unless included as covered under the EOC.

  • Legal Opinions The Administrative Agent shall have received the following executed legal opinions:

  • LIMITATIONS OF COVERED MEDICAL SERVICES In order to be covered, the Member’s Attending Physician must specifically prescribe such services and such services must be consequent to treatment of the cleft lip or cleft palate.

  • Investors of one Contracting Party affected by expropriation shall have a right to prompt review, by a judicial or other independent authority of the other Contracting Party, of their case and of the valuation of their investments in accordance with the principles set out in this Article.

  • Opinions Counterparty shall deliver to Dealer an opinion of counsel, dated as of the Premium Payment Date, with respect to the matters set forth in Sections 8(a) through (c) of this Confirmation; provided that any such opinion of counsel may contain customary exceptions and qualifications. Delivery of such opinion to Dealer shall be a condition precedent for the purpose of Section 2(a)(iii) of the Agreement with respect to each obligation of Dealer under Section 2(a)(i) of the Agreement.

  • Acknowledgement of Existing Physical Conditions In undertaking the work under this Contract, the Contractor acknowledges that he has visited the premises and has taken into consideration all open and apparent conditions that might affect his work. No claim based on lack of knowledge of existing conditions shall be allowed unless the existing physical conditions cannot be discovered by a reasonably observant person. Any claims relating to conditions that are materially different from the Contract Documents that were not open and apparent may be adjusted as provided in this Part.

  • Lodgement of SWS wage assessment agreement C.6.1 All SWS wage assessment agreements under the conditions of this schedule, including the appropriate percentage of the relevant minimum wage to be paid to the employee, must be lodged by the employer with Fair Work Australia.

  • Good Offices, Conciliation and Mediation 1. Good offices, conciliation and mediation are procedures that are undertaken voluntarily if the parties to the dispute so agree.

  • Georgia Security and Immigration Compliance Act Requirements No bid will be considered unless the Contractor certifies its compliance with the Immigration reform and Control Act of 1986 (IRCA), D.L. 99-603 and the Georgia Security Immigration Compliance Act OCGA 13-10-91 et seq. The Contractor shall execute the Georgia Security and Immigration Compliance Act Affidavit, as found in Section 7 of the Construction Contract. Contractor also agrees that it will execute any affidavits required by the rules and regulations issued by the Georgia Department of Audits and Accounts. If the Contractor is the successful bidder, contractor warrants that it will include a similar provision in all written agreements with any subcontractors engaged to perform services under the Contract.

  • Qualified Medical Child Support Order A child who would otherwise meet the eligibility requirements and is required to be covered by a Qualified Medical Child Support Order (QMCSO) is considered an eligible dependent.

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