Concurrent Care Decisions. If CareFirst BlueChoice has approved an ongoing course of treatment to be provided over a period of time or number of treatments:
a. CareFirst BlueChoice will notify the Member of any reduction or termination of such course of treatment (other than by a change in the plan’s coverage by amendment or termination of coverage) before the end of such period of time or number of treatments and at a time sufficiently in advance of the reduction or termination to allow the Member to appeal and obtain a determination on review before the benefit is reduced or terminated.
b. Any request by a Member to extend the course of treatment beyond the period of time or number of treatments that is a claim involving Urgent/Emergent Care will be decided as soon as possible, taking into account the medical exigencies. CareFirst BlueChoice will notify the Member of the benefit determination, whether adverse or not, within 24 hours after receipt of the claim, provided that any such claim is made to CareFirst BlueChoice at least 24 hours prior to the expiration of the prescribed period of time or number of treatments.
Concurrent Care Decisions. If CareFirst has approved an ongoing course of treatment to be provided over a period of time or number of treatments:
a. CareFirst will notify the Member of any reduction or termination of such course of treatment (other than by a change in the plan's coverage by amendment or termination of coverage) before the end of such period of time or number of treatments and at a time sufficiently in advance of the reduction or termination to allow the Member to appeal and obtain a determination on review before the benefit is reduced or terminated.
b. Any request by a Member to extend the course of treatment beyond the period of time or number of treatments that is a claim involving Urgent/Emergent Care will be decided as soon as possible, taking into account the medical exigencies. CareFirst will notify the Member of the benefit determination, whether adverse or not, within 24 hours after receipt of the claim, provided that any such claim is made to CareFirst at least 24 hours prior to the expiration of the prescribed period of time or number of treatments.
Concurrent Care Decisions. Humana will notify a Claimant of a Concurrent-care Decision involving a reduction or termination of pre-authorized benefits sufficiently in advance of the reduction or termination to allow the Claimant to appeal and obtain a determination. Humana will decide Urgent-care Claims involving an extension of a course of treatment as soon as possible taking into account medical circumstances. Humana will notify a Claimant of the benefit determination, whether adverse or not, within 24 hours after the plan receives the claim, provided the claim is submitted to the plan 24 hours prior to the expiration of the prescribed period of time or number of treatments.
Concurrent Care Decisions. Section 6.33 Application of Part IV 6.12 Section 6.34 Definition of Concurrent Care Decision 6.12
Concurrent Care Decisions. If the Fund has approved an ongoing course of treatment to be provided over a period of time or number of treatments, the Board (or its designee) will notify the Claimant sufficiently in advance of any reduction or termination of the course of treatment (other than by Plan amendment or termination) to allow the Claimant to appeal and obtain a decision on appeal before the benefit is reduced or terminated.
Concurrent Care Decisions. If CareFirst has approved an ongoing course of treatment to be provided over a period of time or number of treatments:
a) CareFirst will notify the Member of any reduction or termination of such course of treatment (other than by a change in the plan's coverage by amendment or termination of coverage) before the end of such period of time or number of treatments and at a time sufficiently in advance of the reduction or termination to allow the Member to appeal and obtain a determination on review before the benefit is reduced or terminated.
b) Any request by a Member to extend the course of treatment beyond the period of time or number of treatments that is a claim involving Urgent/Emergent Care will be decided as soon as possible, taking into account the medical exigencies. CareFirst will notify the Member of the benefit determination, whether adverse or not, within twenty-four (24) hours after receipt of the claim, provided that any such claim is made to CareFirst at least twenty-four
Concurrent Care Decisions. If an ongoing course of treatment to be provided over a period of time or number of treatments has been approved, the following procedures shall apply:
(i) Any reduction or termination of such course of treatment (other than by Plan amendment or termination) before the end of such period of time or number of treatments shall constitute an Adverse Benefit Determination. The Organization shall notify the claimant, in accordance with the Notice requirements set forth in Section 11.07, of the Adverse Benefit Determination at a time sufficiently in advance of the reduction or termination to allow the claimant to appeal and obtain a determination on review of that Adverse Benefit Determination before the benefit is reduced or terminated.
(ii) Any request by a claimant to extend the course of treatment beyond the period of time or number of treatments that is a Claim Involving Urgent Care shall be decided as soon as possible, taking into account the medical exigencies, and the Organization shall notify the claimant of the benefit determination, whether adverse or not, within 24 hours after receipt of the claim by the Organization, provided that any such claim is made to the Organization at least 24 hours prior to the expiration of the prescribed period of time or number of treatments. Notification of any Adverse Benefit Determination concerning a request to extend the course of treatment, whether involving Urgent Care or not, shall be made in accordance with the Notice requirements set forth in Section 11.07, and appeal shall be governed by Section 11.08.
Concurrent Care Decisions. If the Plan has approved an ongoing course of treatment to be provided over a period of time or number of treatments, then any reduction or termination by the Plan of such course of treatment (other than by an Amendment of the Plan or its termination) before the end of such period of time or number of treatments shall constitute an adverse benefit determination. The Plan Administrative Manager shall notify the Claimant of the adverse benefit determination at a time sufficiently in advance of the reduction or termination to allow the Claimant to appeal and obtain a determination before the benefit is reduced or terminated. Moreover, any request by a Claimant to extend the course of treatment beyond the period of time or number of treatments that is a Claim involving urgent care shall be decided as soon as possible, taking into account the medical circumstances, and the Plan Administrative Manager shall notify the Claimant of the benefit determination, whether adverse or not, within 24 hours after receipt of the Claim by the Plan, provided that any such Claim is made to the Plan at least 24 hours prior to the expiration of the prescribed period of time or number of treatments. Notification of any adverse benefit determination concerning a request to extend the course of treatment, whether involving urgent care or not, shall be made in compliance with the provisions relating to the Notification of the Decision section, which follows, and the appeal shall be governed by the Notification of the Decision on Appeal sections, which follow, as appropriate.
Concurrent Care Decisions
