Common use of Charges for the Treatment of Hemophilia Clause in Contracts

Charges for the Treatment of Hemophilia. The Providers in Our Network providing Medically Necessary and Appropriate home treatment services for bleeding episodes associated with hemophilia shall comply with standards adopted by the Department of Health and Senior Services in consultation with the Hemophilia Association of New Jersey. We will cover the services of a clinical laboratory at a Hospital with a state-designated outpatient regional care center regardless of whether the Hospital’s clinical laboratory is a [Network] Provider if the Member’s Practitioner determines that the Hospital’s clinical laboratory is necessary because: a) the results of laboratory tests are medically necessary immediately or sooner than the normal return time for Our network clinical laboratory; or b) accurate test results need to be determined by closely supervised procedures in venipuncture and laboratory techniques in controlled environments that cannot be achieved by Our Network clinical laboratory. We will pay the Hospital’s clinical laboratory for the laboratory services at the same rate We would pay a Network clinical laboratory for comparable services.

Charges for the Treatment of Hemophilia. The Providers in Our Network providing Medically Necessary and Appropriate home treatment services for bleeding episodes associated with hemophilia shall comply with standards adopted by the Department of Health and Senior Services in consultation with the Hemophilia Association of New Jersey. We will cover the services of a clinical laboratory at a Hospital with a state-state- designated outpatient regional care center regardless of whether the Hospital’s clinical laboratory is a [Network] Network Provider if the Member’s Practitioner determines that the Hospital’s clinical laboratory is necessary because: a) the results of laboratory tests are medically necessary immediately or sooner than the normal return time for Our network clinical laboratory; or b) accurate test results need to be determined by closely supervised procedures in venipuncture and laboratory techniques in controlled environments that cannot be achieved by Our Network clinical laboratory. We will pay the Hospital’s clinical laboratory for the laboratory services at the same rate We would pay a Network clinical laboratory for comparable services.