Common use of Concurrent Care Claim Extension Clause in Contracts

Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-service claim depending on the circumstances. Treated like an urgent care claim or a pre-service claim depending on the circumstances Post-Service Claim. Any claim for a benefit that is not a pre- service claim. Within 30 calendar days Review provided by HMO personnel not involved in making the adverse benefit determination. Within 30 calendar days Review provided by HMO Appeals Committee. A Member and/or an authorized representative may attend the Level Two Appeal hearing and question the representative of HMO and/or any other witnesses, and present their case. The hearing will be informal. A Member’s Physician or other experts may testify. HMO also has the right to present witnesses.

Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-pre- service claim depending on the circumstances. circumstances Treated like an urgent care claim or a pre-pre- service claim depending on the circumstances Post-Service Claim. Any claim for a benefit that is not a pre- pre-service claim. Within 30 calendar days Review provided by HMO personnel not involved in making the adverse benefit determination. Within 30 calendar days Review provided by HMO Appeals Committee. A Member and/or an authorized representative may attend the Level Two Appeal hearing and question the representative of HMO and/or any other witnesses, and present their case. The hearing will be informal. A Member’s Physician or other experts may testify. HMO also has the right to present witnesses.

Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-service claim depending on the circumstances. Treated like an urgent care claim or a pre-service claim depending on the circumstances circumstances. Post-Service Claim. Any claim for a benefit that is not a pre- service claim. Within 30 calendar days Review provided by HMO personnel not involved in making the adverse benefit determination. determination Within 30 calendar days Review provided by HMO Appeals Committee. Review provided by HMO personnel not involved in making the adverse benefit determination or Level One Appeal decision A Member and/or an authorized representative may attend the Level Two Two-Appeal hearing and question the representative of HMO and/or any other witnesses, and present their case. The hearing will be informal. A Member’s Physician or other experts may testify. HMO also has the right to present witnesses.

Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-service claim depending on the circumstances. Treated like an urgent care claim or a pre-service claim depending on the circumstances Post-Service Claim. Any claim for a benefit that is not a pre- pre-service claim. Within 30 calendar days Review provided by HMO personnel not involved in making the adverse benefit determination. Within 30 calendar days Review provided by HMO Appeals Committeepersonnel not involved in making the adverse benefit determination. A Member and/or an authorized representative may attend the Level Two Appeal hearing and question the representative of HMO and/or any other witnesses, and present their case. The hearing will be informal. A Member’s Physician or other experts may testify. HMO also has the right to present witnesses.

Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-pre- service claim depending on the circumstances. circumstances Treated like an urgent care claim or a pre-pre- service claim depending on the circumstances Post-Service Claim. Any claim for a benefit Within 30 calendar days Within 30 calendar days that is not a pre- pre-service claim. Within 30 calendar days Review provided by HMO personnel not involved in making the adverse benefit determination. Within 30 calendar days Review provided by HMO Appeals Committee. A Member and/or an authorized representative may attend the Level Two Appeal hearing and question the representative of HMO and/or any other witnesses, and present their case. The hearing will be informal. A Member’s Physician or other experts may testify. HMO also has the right to present witnesses.

Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-pre- service claim depending on the circumstances. circumstances Treated like an urgent care claim or a pre-pre- service claim depending on the circumstances Post-Service Claim. Any claim for a benefit that is not a pre- pre-service claim. Within 30 calendar days Review provided by HMO personnel not involved in making the adverse benefit determination. Within 30 calendar days Review provided by HMO Appeals Committee. Review provided by HMO personnel not involved in making the adverse benefit determination or Level One Appeal decision. A Member and/or an authorized representative may attend the Level Two Appeal hearing and question the representative of HMO and/or any other witnesses, and present their case. The hearing will be informal. A Member’s Physician or other experts may testify. HMO also has the right to present witnesses.