Continuing or Follow-up Treatment. Except as provided for under “Continuing Treatment Following Emergency Surgery,” we do not cover continuing or follow-up treatment after Emergency Services unless authorized by Health Plan. We cover only the out-of-Plan emergency Services that are required before you could, without medically harmful results, have been moved to a facility we designate either inside or outside our Service Area or in another Xxxxxx Foundation Health Plan or allied plan service area.
Continuing or Follow-up Treatment. If you receive Emergency Services from a Hospital which is a non-Plan Hospital, follow-up care must be authorized by Blue Shield or it may not be covered. If, once your Emergen- cy medical condition is stabilized, and your treating health care provider at the non-Plan Hospital believes that you require additional Medically Necessary Hospital Services, the non-Plan Hospital must contact Blue Shield to obtain timely authorization. Blue Shield may author- ize continued Medically Necessary Hospital Services by the non-Plan Hospital. If Blue Shield determines that you may be safely transferred to a Hospital that is con- tracted with the Plan and you refuse to consent to the transfer, the non-Plan Hospital must provide you with written notice that you will be financially responsible for 100% of the cost for Services provided to you once your Emergency condition is stable. Also, if the non-Plan Hospital is unable to determine the contact information at Blue Shield in order to request prior authorization, the non-Plan Hospital may xxxx you for such services. If you believe you are improperly billed for services you re- ceive from a non-Plan Hospital, you should contact Blue Shield at the telephone number on your identification card. FAMILY PLANNING AND INFERTILITY BENEFITS
Continuing or Follow-up Treatment. If you receive Emergency Services from a Hospital which is a non-Plan Hospital, follow-up care must be authorized by Blue Shield or it may not be covered. If, once your Emergency medical condition is stabilized, and your treating health care provider at the non-Plan Hospital believes that you require additional Medically Necessary Hospital Ser- vices, the non-Plan Hospital must contact Blue Shield to obtain timely authorization. Blue Shield may authorize continued Medically Necessary Hospital Services by the non-Plan Hospital. If Blue Shield determines that you may be safely transferred to a Hospital that is contracted with the Plan and you refuse to consent to the transfer, the non-Plan Hospital must provide you with written notice that you will be financially responsible for 100% of the cost for Services provided to you once your Emergency condition is stable. Also, if the non-Plan Hospital is una- ble to determine the contact information at Blue Shield in order to request prior authorization, the non-Plan Hospi- tal may xxxx you for such services. If you believe you are improperly billed for services you receive from a non- Plan Hospital, you should contact Blue Shield at the tele- phone number on your identification card. FAMILY PLANNING AND INFERTILITY BENEFITS
Continuing or Follow-up Treatment. Continuing or kpgroup_bensch_16r.doc B-11 rev 07/2015 follow-up treatment from a physician, hospital or other non- Health Plan designated medical practitioner is not covered unless treatment meets the criteria for Emergency Services or Urgent Care Services. Payment is limited to Urgent Care Services outside the Service Area and Emergency Services which are required before the Member can, without medically harmful consequences, be transported to a Hospital or Medical Office in the Service Area, or, if the Member is near another Health Plan Region, be transported to a contracting hospital or medical office in the other Health Plan Region, except that Health Plan at its option may continue inpatient coverage in lieu of transferring the Member. If the Member obtains prior approval from Health Plan or a Physician in the Service Area, covered benefits include the cost of necessary ambulance service or other special transportation arrangements medically required to transport the Member to a Hospital or Medical Office in the Service Area or to a contracting hospital or medical office in the nearest other Health Plan Region for continuing or follow-up treatment.
Continuing or Follow-up Treatment. Except as provided for under “Continuing Treatment Following Emergency Surgery,” we do not cover continuing or follow-up treatment after Emergency Services unless authorized by Health Plan. We cover only the out-of-Plan emergency Services that are required before you could, without medically harmful results, have been moved to a facility we designate either inside or outside our Service Area or in another Xxxxxx Foundation Health Plan or allied plan service area. Hospital Observation: Transfer to an observation bed or observation status does not qualify as an admission to a hospital and your emergency room visit copayment will not be waived.
