Common use of Emergency Room Services Co-Payment Clause in Contracts

Emergency Room Services Co-Payment. HIP A co-payment will apply to non-emergency use of an emergency room by HIP members. Emergency room care includes care given for a medical emergency when a member believes that their health is in serious danger and every second counts (see also: 42 CFR § 405.440). Other than HIP members exempt from cost-sharing as described in Section 13.1.4, all HIP members will be subject to a co-payment for all non-urgent use of hospital emergency department services. The member will incur an $8 co-payment for any inappropriate emergency department visit. Providers will collect the co-payment from members, and POWER Account funds cannot be used by the member to pay the co-payment. The Contractor shall include co-payment information on the member’s ID card which directs the provider to call the Contractor for specific co- payment amount due, as the member may have received a copay waiver by calling the Contractor’s nurse hotline, as described below. Per IC 27-13-1-7, copayment means an amount, or a percentage of the charge, that an enrollee must pay to receive a specific service that is not fully prepaid. All members shall receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active Labor Act. The co- payment shall be waived or returned if the member is found to have an emergency condition, as defined in section 1867(e)(1)(A) of the Emergency Medical Treatment and Active Labor Act, or if the member is admitted to the hospital within twenty-four