Continuing Treatment Following Emergency Surgery. If we authorize, direct, refer or otherwise allow you to access a hospital emergency facility or other urgent care facility for a medical condition that requires emergency surgery, we will reimburse the physician, oral surgeon, periodontist or podiatrist who performed the surgical procedure for follow-up care that is:
Continuing Treatment Following Emergency Surgery. If we authorize, direct, refer, or otherwise allow you to access a hospital emergency facility or other urgent care facility for a medical condition that requires emergency surgery, we will reimburse the physician, oral surgeon, periodontist or podiatrist who performed the surgical procedure for follow-up care that is: • medically necessary; • directly related to the condition for which the surgical procedure was performed; and • provided in consultation with the Member’s primary care Plan Physician. We will not impose any Copayment or other cost- sharing requirement for follow-up care that exceeds that which you would be required to pay had the follow-up care been rendered by Plan Providers within our Service Area.
Continuing Treatment Following Emergency Surgery. We will not impose any Copayment or other cost-sharing requirement for follow-up care that exceeds that which you would be required to pay had the follow-up care been rendered by Plan Providers within our Service Area. Post-Stabilization Care Post-Stabilization Care is Medically Necessary Services related to your Emergency Medical Condition that you receive in a hospital (including the Emergency Department) after your treating physician determines that your Emergency Medical Condition is stabilized. Post-stabilization Care also includes durable medical equipment covered under this EOC, if it is Medically Necessary after your discharge from a hospital and related to the same Emergency Medical Condition. For more information about durable medical equipment covered under this EOC, see “Durable Medical Equipment” in the “Benefits, Exclusions and Limitations and Summary of Services and Cost Shares.” When you receive Emergency Services in Maryland (and federal law does not require that we consider the Post-Stabilization Care as Emergency Services), We cover Post-Stabilization Care only if We provide Prior Authorization for the Post-Stabilization Care. Therefore, it is very important that You, Your provider including Your non-Participating Provider, or someone else acting on Your behalf, call us to notify Us that You need Post Stabilization Care and to get Prior Authorization from us before You receive the Post-Stabilization Care. To request Prior Authorization, You, Your provider including Your non-Participating Provider (or someone else acting on your behalf) must call 0-000-000-0000 or the notification telephone number on the reverse side of your ID card before you receive the care. We will discuss your condition with the non-Participating Provider. If we determine that you require post-stabilization care, we will authorize your care from the non-Participating Provider or arrange to have a Participating Provider (or other designated provider) provide the care. If we decide to have a Plan Hospital, Plan Skilled Nursing Facility, or designated non-Participating Provider provide your care, we may authorize special transportation services that are non-Participating Providers. If you receive care from a non-Participating Provider that we have not authorized, you may have to pay the full cost of that care. When you receive Emergency Services from non-Participating Providers, Post Stabilization Care may qualify as Emergency Services pursuant to federal law. We will n...
