Continuing Care. Group shall have sole responsibility for --------------- all development and execution of continuing care protocols intended to maintain the patient's condition over the course of time.
Continuing Care. Medically Necessary care provided by any Provider other than a Member’s Primary Care Physician will be covered, subject to the Section CS - Description of Covered Services, Section EX - Exclusions, Section SC - Schedule of Cost Sharing sections, and the Medical Care Preauthorization Schedule only until they can, without medically harmful consequences, be transferred to the care of their Primary Care Physician or a Referred Specialist designated by their Primary Care Physician. All continuing care must be provided or Referred by a Member’s Primary Care Physician or coordinated through Keystone’s Customer Service Department. Members who will be out of Keystone’s Approved Service Area for an extended period of time may wish to enroll in Keystone’s Away From Home Care Guest Membership Program. This program gives Members coverage, similar to that provided by Keystone, and the BlueCross and/or BlueShield HMO in that particular geographic area. Members will have a PCP both at the guest HMO and in Keystone’s Limited Network Area. Essentially, the Member is covered under two (2) plans at the same time at no additional cost. Members who take extended business trips (three to six months), students at college, or families living apart may all take advantage of the benefit of a Guest Membership. Not all geographic areas within the United States participate in the Guest Membership Program. Members should contact Keystone’s Customer Service Department by calling the telephone number on their ID card or as outlined in this Agreement to find out if the geographic area where they will be staying participates in the Guest Membership Program and to find out if they are eligible. Subscribers who will be out of Keystone’s Approved Service Area for greater than six (6) months or who change their permanent residence to an address outside of Keystone’s Limited Network Area, are not eligible for the Guest Membership Program.
Continuing Care. Not prohibit the Practitioner from providing continuing care and treatment to a specific patient during the course of the patient’s acute illness; provided, however, the Practitioner shall give the Employer written notice of any patient for whom the Practitioner is assuming the responsibility to provide such continuing care and treatment, along with a copy of proper written patient authorization for the Practitioner to access and/or obtain copies of the patient’s records.
Continuing Care. You agree that upon termination of this Agreement or our insolvency, you will remain obligated to continue to provide medical care pursuant to applicable state and federal statutes and consistent with requirements in the Provider Manual to State Health Plan Members that are receiving ongoing care until we can arrange for the State Health Plan Member to select another provider or ninety (90) days from the date of termination, whichever occurs first. You further agree that upon termination of this Agreement or our insolvency, you will be obligated to continue inpatient care until the State Health Plan Member is ready for discharge. In the event of our insolvency, you will be obligated to continue to provide Covered Services for the period for which the State Health Plan Member’s premium has been paid. You agree to continue to be obligated to the terms of this Agreement for any such continuing care required under this Section 5.3.
1. If a given State Health Plan Member falls into more than one of the above categories such that a conflict is created as to the length of time that you are required to provide care, the longer time period shall apply.
Continuing Care. A medical investigation, obtaining treatment or surgery that is not preapproved after the initial consultation for your medical emergency. The travel assistance provider must assess and approve any additional medical treatment. This includes invasive testing or surgery (e.g. cardiac catheterization, other cardiac procedures, transplant and MRI).
Continuing Care. SECTION GM - AWAY FROM HOME CARE PROGRAM® GUEST MEMBERSHIP BENEFITS
Continuing Care. CONTRACTOR may operate a Continuing Care Program following 30 graduation and Participant’s release to community residence. Continuing Care should consist of 31 activities supportive of continuing sobriety and community integration.
Continuing Care. If questions arise about the medical necessity of continued care for treatment or services, the Plan can ask the attending physician to provide evidence supporting the need for this care. The Plan can discontinue payment of benefits if the medical information from your physician does not clearly indicate that continued care for treatment or services is medically necessary.
Continuing Care. Except for claims subject to the CHAMPUS DRG-based payment system, whenever medical services and supplies are being ren- dered on a continuing basis, an appro- priate claim or claims should be sub- mitted every 30 days (monthly) wheth- er submitted directly by the bene- ficiary or sponsor or by the provider on behalf of the beneficiary. Such claims may be submitted more frequently if the beneficiary or provider so elects. The Director, OCHAMPUS, or a des- ignee, also may require more frequent claims submission based on dollars. Ex- amples of care that may be rendered on a continuing basis are outpatient phys- ical therapy, private duty (special) nursing, or inpatient stays. For claims subject to the CHAMPUS DRG-based payment system, claims may be sub- mitted only after the beneficiary has been discharged or transferred from the hospital.
Continuing Care. The parties agree that in carrying out the Services described in this Agreement, the Lab does not assume any responsibility for continuing medical care and/or treatment of the Patient’s whose tests and Results may be handled by the Lab in performance of this Agreement.
