Emergency Services and Urgent Care. A. Benefits are available to a Member for Emergency Services and Urgent Care twenty-four
Emergency Services and Urgent Care. CareFirst BlueChoice provides coverage for the services listed below at hospital emergency rooms and Urgent Care facilities inside or outside of the Service Area.
Emergency Services and Urgent Care. If Members receive Emergency Services or Urgent Care from a Provider outside of Keystone’s Limited Network Area, and the Provider is a Member of the local Blue Plan, Members should show their ID card to the Provider. The Provider will file a claim with the local Blue Plan that will in turn electronically route the claim to Keystone for processing. Keystone applies the applicable benefits and Cost-Sharing Amounts to the claim. This information is then sent back to the local Blue Plan that will in turn make payment directly to the Participating Provider – after applicable Cost-Sharing Amounts, if any, have been applied. For Professional Providers and Facility Providers, the benefit payment amount is based on the Allowable Amount on the date the service is rendered. Benefit payments to Hospitals or other Facility Providers may be adjusted from time to time based on settlements with such Providers. Such adjustments will not affect the Member’s Cost-Sharing Amount obligations. If it is necessary for Members to submit a claim to Keystone, they should be sure to request an itemized xxxx from their health care Provider. The itemized xxxx should be submitted to Keystone with a completed Keystone Health Plan Central Claim Form. Members can obtain a copy of the Keystone Health Plan Central Claim Form by contacting Customer Service or visiting the Member link on Keystone’s website at xxxxxxxxxxxx.xxx. The Member’s claim will be processed more quickly when the Keystone Health Plan Central Claim Form is used. A separate claim form must be completed for each Member who received medical services. Members should include all of the following information with their claim:
Emergency Services and Urgent Care. The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four
Emergency Services and Urgent Care. FHCN PACE provides emergency care 24 hours per day, 7 days per week, and 365 days per year. An emergency is a life-threatening medical condition. If not diagnosed and treated immediately, emergent medical conditions could result in serious and permanent damage to your health. Examples of an emergency can include: ● Chest pain / symptoms of a heart attack ● Unexpected or sudden loss of consciousness ● Choking ● Severe difficulty breathing ● Symptoms of a stroke ● Severe bleeding ● Sudden unexpected onset of a serious illness ● Serious injury from a fall After you have used the “911” emergency response system, you or your family must notify FHCN PACE as soon as reasonably possible in order to maximize the continuity of your medical care. care and transferring your care to a FHCN PACE contracted provider when your medical condition is stabilized. Before you leave the FHCN PACE service area to go out of town, please notify your IDT through your FHCN PACE Social Worker. Your Social Worker will explain what to do if you become ill while you are away from your FHCN PACE Physician. Make sure that you keep your FHCN PACE membership card with you at all times, especially when traveling out of the service area. Your card identifies you as a FHCN PACE participant and provides information to care providers (emergency rooms and hospitals) about your health care coverage and how to reach us, if necessary. If you are out of FHCN PACE service area for more than 30 days, FHCN PACE may disenroll you unless FHCN PACE agrees to a longer absence due to extenuating circumstances, such as when a participant is hospitalized or out of the service area during the initial 30 days of enrollment, or services are disrupted due to catastrophic weather-related events. FHCN PACE covers both Emergency Services and Urgent Care when you are temporarily out of our service area but still in the United States or its territories. If you use Emergency Services when out of the service area (for example, ambulance or inpatient services), you must notify FHCN PACE within 48 hours or as soon as reasonably possible. If you are hospitalized, we have the right to arrange a transfer when your medical condition is stabilized, to a FHCN PACE contracted hospital or another hospital designated by us. We may also transfer your care to a FHCN PACE physician. Urgent Care includes inpatient or outpatient services that are necessary to prevent serious deterioration of your health resulting from an unforeseen illne...
Emergency Services and Urgent Care. WHERE CAREFIRST BLUECHOICE PROVIDES MEMBER PAYS
Emergency Services and Urgent Care. Non-emergency care in a hospital emergency room facility Non-urgent care in an urgent care facility (at a non-hospital freestanding facility)
Emergency Services and Urgent Care. On Lok Lifeways provides emergency care 24 hours per day, 7 days per week, 365 days per year. An Emergency Medical Condition means a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in the following:
Emergency Services and Urgent Care. EMERGENCY SERVICES AND URGENT CARE
Emergency Services and Urgent Care resulting from an unforeseen illness or injury for which treatment cannot be delayed until you return to our service area. If you use emergency services or urgent care when out of the service area (for example, ambulance or inpatient services), you must notify CalOptima PACE within 48 hours or as soon as reasonably possible. If you are hospitalized, we have the right to arrange a transfer when your medical condition is stabilized to a CalOptima PACE contracted hospital or another hospital designated by us. We may also transfer your care to a CalOptima PACE physician. CalOptima PACE will pay for all medically necessary health care services provided to you that are necessary to maintain your stabilized condition up to the time that CalOptima PACE arranges your transfer or you are discharged. CalOptima PACE must approve any routine medical services (i.e., medical services that do not constitute a medical emergency or other urgent need for care) when you are out of the service area. For authorization of any non-emergency, out-of-the-area services, you must call CalOptima PACE at 0-000-000-0000 or Toll-Free 0-000-000-0000 and speak with your nurse, social worker or PCP. If you have paid for emergency services or urgent care you received when you were outside our service area but still in the United States, CalOptima PACE will reimburse you. Request a receipt from the facility or physician involved at the time you pay. This receipt must show: the physician’s name, your health problem, date of treatment and release, as well as charges. Please send a copy of this receipt to your CalOptima PACE social worker within 30 business days. Please note that if you receive any medical care or covered services as described in this document outside of the United States, CalOptima PACE will not be responsible for the charges.
