Emergency Admissions. Emergency inpatient hospital confinements including inpatient psychiatric treatment must be certified within 48 hours of admission or a ten percent (10%) penalty will be applied to total charges in addition to the deductible, coinsurance and out-of-pocket maximum. In the event the care is provided by a non-network provider and is determined to be medically unnecessary, the employee will be responsible for the cost of all such medically unnecessary care.
Emergency Admissions. An emergency room visit will be subject to a seventy-five dollar ($75.00) co-pay per visit and twenty percent (20%) co- insurance after the co-pay and deductible. If admitted, the co-pay will be waived. Mental health services will not be subject to the emergency room or Urgent Care co-pay. Annual deductible, co-insurance and out of pocket maximums will apply.
Emergency Admissions. 7.1 In the case of an emergency admission the Care Provider may accept a Service User before a CSO has been completed and accepted by the Care Provider. In such cases the placement shall be deemed to have been made in accordance with the terms, conditions, specifications and standards contained in this Agreement or any variation thereof agreed in writing between the parties and a CSO shall be completed as authorisation by the parties as soon as it is reasonably practicable.
7.2 Within 7 days of the emergency admission of a Service User pursuant to the arrangements set out above at paragraph 7.1, the Care Provider will
7.2.1 inform the Service User or his representative of his potential eligibility for RNCCs;
7.2.2 use reasonable endeavours to supply the Service User or his representative with any relevant information, including a RNCC Guidance Leaflet entitled “NHS Funded Nursing Care in Nursing Homes”, and such further or other information leaflets as the Care Provider may be provided by the PCT.
7.3 It will be considered as consent given unless the Service User or their representatives informs the LA in writing within 14 days of receipt of the information of their decision to opt out of the services offered.
7.4 Upon receipt of any such consent from the Service User (or his representative),and within 14 days of such notice, the PCT will arrange for an assessment of the Service User to be undertaken by a Registered Nursing Care Assessor;
7.5 Upon completion of the assessment of each Service User, the PCT will provide to the LA the following information within 14 days:
7.5.1 a written statement setting out:
7.5.1.1 the amount of the RNCC which the PCT will pay the LA for the provision of nursing care and continence products to that Service User;
7.5.1.2 the date upon which those payments will commence; and
7.5.1.3 details of any further equipment or services which are to be provided to that Service User by the PCT .
7.6 Where the emergency admission is confirmed, a CSO, written notification of entitlement and financial arrangements to be issued. Where the emergency admission is not confirmed, LA and PCT to be liable for costs of seven day period only.
Emergency Admissions. In case of emergencies also, the procedure specified in Clause (I) (1), (2) and (3) shall be followed.
Emergency Admissions. If you must be hospitalized in a Non-Plan Hospital or Non- Participating Hospital immediately following Emer- gency Accident Care or Emergency Medical Care, benefits will be provided at the Participating Provider Hospital payment level for that portion of your Inpatient Hospital stay during which your condition is reasonably deter- mined by Blue Cross and Blue Shield to be serious and therefore not permitting your safe transfer to a Participat- ing Hospital or other Participating Provider. For that portion of your Inpatient Hospital stay during which your condition is reasonably determined by Blue Cross and Blue Shield not to be serious, benefits will be provided at 50% of the Eligible Charge for Covered Ser- vices if you are in a Non-Plan Hospital or at the Non- Participating Provider Hospital payment level, if you are in a Non-Participating Hospital. In order for you to continue to receive benefits at the Participating Hospital payment level following an emergency admission to a Non-Plan or Non-Participating Hospital, you must transfer to a Participating Hospital or other Participating Provider as soon as your condition is no longer serious.
