Common use of Emergency Services, Generally Clause in Contracts

Emergency Services, Generally. (A) The Contractor is responsible for coverage and payment of Emergency Dental Services in a dental provider’s office as described by this Contract and by law. (B) The Contractor shall cover and pay for Emergency Dental Services, 24 hours a day 7 days a week whether the servicing provider is a Network Provider or a Non Network Provider. (C) The Contractor may not limit what constitutes an Emergency Medical Condition with reference to the definition of an Emergency Medical Condition on the basis of lists of diagnoses or symptoms. (D) The Contractor may not refuse to cover Emergency Services based on the emergency room Provider, hospital, or fiscal agent not notifying the Enrollee’s Primary Care Dentist or the Contractor of the Enrollee’s screening and treatment within ten calendar days of presentation for Emergency Services. (E) The Contractor shall inform Enrollees that access to Emergency Dental Services is not restricted and that if an Enrollee experiences a dental emergency, he or she may obtain services from a Non-Participating Provider without penalty.

Emergency Services, Generally. (A) The Contractor is responsible for coverage and payment of Emergency Dental Services in a dental provider’s office for treatment of Emergency Medical Conditions as described by this Contract contract and by law. (B) The Contractor shall cover and pay for Emergency Dental Services, 24 hours a day 7 days a week week, whether the servicing provider is a Network Provider or a Non Non-Network ProviderProvider regardless of the service area. (C) The Contractor may not limit what constitutes an Emergency Medical Condition with reference to the definition of an Emergency Medical Condition on the basis of lists of diagnoses or symptoms. (D) The Contractor may not refuse to cover Emergency Services based on the emergency room Provider, hospital, or fiscal agent not notifying the Enrollee’s Primary Care Dentist Provider or the Contractor of the Enrollee’s screening and treatment within ten calendar days of presentation for Emergency Services. (E) The Contractor shall inform Enrollees that access to Emergency Dental Services is not restricted and that if an Enrollee experiences a dental medical emergency, he or she may obtain services from a Non-Participating Provider without penalty.