Common use of Concurrent Care Claim Reduction or Termination Clause in Contracts

Concurrent Care Claim Reduction or Termination. Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. With enough advance notice to allow the Member to file an Appeal. If the Member files an Appeal, Covered Benefits under the Certificate will continue for the previously approved course of treatment until a final Appeal decision is rendered. During this continuation period, the Member is responsible for any Copayments that apply to the services; supplies; and treatment; that are rendered in connection with the claim that is under Appeal. If HMO's initial claim decision is upheld in the final Appeal decision, the Member will be responsible for all charges incurred for services; supplies; and treatment; received during this continuation period. Post-Service Claim. A claim for a benefit that is not a pre-service claim. Within 30 calendar days. HMO may determine that due to matters beyond its control an extension of this 30-calendar day claim decision period is required. Such an extension, of not longer than 15 additional calendar days, will be allowed if HMO notifies the Member within the first 30 calendar day period. If this extension is needed because HMO needs more information to make a claim decision, the notice of the extension shall specifically describe the required information. The Member will have 45 calendar days, from the date of the notice, to provide HMO with the required information.

Concurrent Care Claim Reduction or Termination. Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. With enough advance notice to allow the Member to file an Appeal. If the Member files an Appeal, Covered Benefits under the Certificate will continue for the previously approved course of treatment until a final Appeal decision is rendered. During this continuation period, the Member is responsible for any Copayments that apply to the services; supplies; and treatment; that are rendered in connection with the claim that is under Appeal. If HMO's ’s initial claim decision is upheld in the final Appeal decision, the Member will be responsible for all charges incurred for services; supplies; and treatment; received during this continuation period. Post-Service Claim. A claim for a benefit that is not a pre-service claim. Within 30 calendar days. HMO may determine that due to matters beyond its control an extension of this 30-30 calendar day claim decision period is required. Such an extension, of not longer than 15 additional calendar days, will be allowed if HMO notifies the Member within the first 30 calendar day period. If this extension is needed because HMO needs more information to make a claim decision, the notice of the extension shall specifically describe the required information. The Member will have 45 calendar days, from the date of the notice, to provide HMO HMO, with the required information.

Concurrent Care Claim Reduction or Termination. Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. With enough advance notice to allow the Member to file an Appeal. If the Member files an Appeal, Covered Benefits under the Certificate will continue for the previously approved course of treatment until a final Appeal decision is rendered. During this continuation period, the Member is responsible for any Copayments that apply to the services; supplies; and treatment; that are rendered in connection with the claim that is under Appeal. If HMO's initial claim decision is upheld in the final Appeal decision, the Member will be responsible for all charges incurred for services; supplies; and treatment; received during this continuation period. Post-Service Claim. A claim for a benefit that is not a pre-pre- service claim. Within 30 calendar days. HMO may determine that due to matters beyond its control an extension of this 30-calendar day claim decision period is required. Such an extension, of not longer than 15 additional calendar days, will be allowed if HMO notifies the Member within the first 30 calendar day period. If this extension is needed because HMO needs more information to make a claim decision, the notice of the extension shall specifically describe the required information. The Member will have 45 calendar days, from the date of the notice, to provide HMO with the required information.

Concurrent Care Claim Reduction or Termination. Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. With enough advance notice to allow the Member to file an Appeal. If the Member files an Appeal, Covered Benefits under the Certificate will continue for the previously approved course of treatment until a final Appeal decision is rendered. During this continuation period, the Member is responsible for any Copayments that apply to the services; supplies; , supplies and treatmenttreatmen; that are rendered in connection with the claim that is under Appeal. If HMO's initial claim decision is upheld in the final Appeal decision, the Member will be responsible for all charges incurred for services; supplies; , supplies and treatment; treatment received during this continuation period. Post-Service Claim. A claim for a benefit that is not a pre-pre- service claim. Within 30 calendar days. HMO may determine that due to matters beyond its control an extension of this 30-calendar day claim decision period is required. Such an extension, of not longer than 15 additional calendar days, will be allowed if HMO notifies the Member within the first 30 calendar day period. If this extension is needed because HMO needs more information to make a claim decision, the notice of the extension shall specifically describe the required information. The Member will have 45 calendar days, from the date of the notice, to provide HMO with the required information.

Concurrent Care Claim Reduction or Termination. With enough advance notice to allow the Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. With enough advance notice to allow the Member to file an Appeal. If the Member files an Appeal, Covered Benefits under the Certificate will continue for the previously approved course of treatment until a final Appeal decision is rendered. During this continuation period, the Member is responsible for any Copayments that apply to the services; supplies; , supplies and treatment; treatment that are rendered in connection with the claim that is under Appeal. If HMO's initial claim decision is upheld in the final Appeal decision, the Member will be responsible for all charges incurred for services; supplies; , supplies and treatment; treatment received during this continuation period. Post-Service Claim. A claim for a benefit that is not a pre-pre- service claim. Within 30 calendar days. HMO may determine that due to matters beyond its control an extension of this 30-calendar day claim decision period is required. Such an extension, of not longer than 15 additional calendar days, will be allowed if HMO notifies the Member within the first 30 calendar day period. If this extension is needed because HMO needs more information to make a claim decision, the notice of the extension shall specifically describe the required information. The Member will have 45 calendar days, from the date of the notice, to provide HMO with the required information.