Concurrent Care. For benefit determinations relating to care that is being received at the same time as the determination, such notice will be provided no later than 24 hours after re ceipt of your Claim for benefits. An appeal is an oral or written request for review of an Adverse Benefit Determ ination (as defined below) or an adverse action by the Plan, its employees or a Provider. CLAIM APPEAL PROCEDURES Claim Appeal Procedures - Definitions
Concurrent Care i) Medical care rendered concurrently with Surgery during one (1) Inpatient stay by a Professional Provider other than the operating surgeon for treatment of a medical condition separate from the condition for which Surgery was performed.
Concurrent Care. Services rendered to an Inpatient in a Hospital, Rehabilitation Hospital or Skilled Nursing Facility by a Professional Provider who is not in charge of the case but whose particular skills are required for the treatment of complicated conditions. This does not include observation or reassurance of the Covered Person, standby services, routine preoperative physical examinations or Medical Care routinely performed in the pre- or post-operative or pre- or post-natal periods or Medical Care required by a Facility Provider's rules and regulations.
Concurrent Care. For benefit determinations relating to care that is being received at the same time as the determination, such notice will be provided no later than 24 hours after receipt of Your claim for benefits. Note: If HMO is seeking to discontinue coverage of prescription drugs or intravenous infusions for which You are receiving health benefits under the plan, You will be notified no later than the 30th day before the date on which coverage will be discontinued. This notice will explain Your rights to expedited appeal and immediate review by an Independent Review Organization. Claim Appeal Procedures
Concurrent Care. Medical care rendered concurrently with surgery during one Hospital admission by a Physician other than the operating surgeon for treatment of a medical condition different from the condition for which surgery was performed; or Medical care by two or more Physicians rendered concurrently during one Hospital admission when the nature or severity of the Member’s condition requires the skills of separate Physicians.
Concurrent Care. If the Claims Administrator has approved an ongoing course of treatment to be provided over a period of time or number of treatments and the Claims Administrator makes a decision to reduce or terminate such course of treatment (other than by plan amendment or plan termination) before the end of the period of time or number of treatments, then the Claims Administrator will notify the claimant sufficiently in advance of the reduction or termination of the benefit to allow him or her to appeal and obtain a decision on review before the benefit is reduced or terminated. If the Claims Administrator receives a request by the claimant to extend beyond the approved period of time or approved number of treatments a course of treatment that qualifies as "urgent care" , the Claims Administrator will notify the claimant of its determination no later than 24 hours after receipt of the claim, provided the claim is made at least 24 hours before the course of treatment otherwise is scheduled to terminate.
Concurrent Care. Injured Workers shall receive treatment from only one (1) type of rehabilitation service at a time. It is the RMT’s responsibility to determine if the Injured Worker is receiving other types of treatment from WorkSafeBC. The RMTs shall not provide Services to Injured Workers who are concurrently receiving other types of treatment, unless it is pre-approved by the Board Officer.
Concurrent Care. A request for Precertification or Predetermination that is conducted during an ongoing course of treatment or admission. If we have approved an ongoing course of treatment to be provided over a period of time or a number of treatments, any reduction or termination by us of such course of treatment before the end of such period of time or number of treatments shall constitute a benefit determination adverse to the Covered Person. We will notify the Covered Person sufficiently in advance of the reduction or termination to allow you to appeal and obtain a determination before the benefit is reduced or terminated.
