Common use of Healthcare Services Clause in Contracts

Healthcare Services. If you are admitted as an Inpatient to the Hospital, you or your Practitioner needs to notify us as soon as possible so we can review your Hospital stay. We will not deny a claim for Emergency Health services when the Member was referred to the emergency room by his or her PCP or by our representative. If your Emergency Health services results in a hospitalization directly from the emergency room, you are responsible for paying the Inpatient Hospital Cost Sharing amounts (Deductible, Coinsurance and/or Copayment) rather than the emergency room visit Copayment. Refer to your Summary of Benefits and Coverage for the required Cost Sharing. For Emergency Healthcare Services received Out-of-network and/or outside of New Mexico (our Service Area), you may seek Emergency Healthcare Services from the nearest appropriate facility where Emergency Healthcare Services can be rendered. Non-emergent follow-up care received outside of New Mexico is not Covered unless transfer to an In-network Practitioner/Provider would be medically inappropriate and a risk to your health. In such circumstances, we must Authorize the Healthcare Services. Non-emergent follow-up care outside of New Mexico is not Covered for your convenience or preference. You are responsible for any such charges that we do not Authorize. Follow-up care from an Out-of-network Practitioner/Provider requires our Prior Authorization.

Healthcare Services. If you are admitted as an Inpatient to the Hospital, you or your Practitioner needs to notify us as soon as possible so we can review your Hospital stay. We will not deny a claim for Emergency Health services when the Member was referred to the emergency room by his or her PCP or by our representative. If your Emergency Health services results in a hospitalization directly from the emergency room, you are responsible for paying the Inpatient Hospital Cost Sharing amounts (Deductible, Coinsurance and/or Copayment) rather than the emergency room visit Copayment. Refer to Ambulance Services in your Summary of Benefits and Coverage for the required Cost SharingSharing for inter-facility transportation costs. For Emergency Healthcare Services received Out-of-network and/or outside of New Mexico (our Service Area), you may seek Emergency Healthcare Services from the nearest appropriate facility where Emergency Healthcare Services can be rendered. Non-emergent follow-up care received outside of New Mexico is not Covered unless transfer to an In-network Practitioner/Provider would be medically inappropriate and a risk to your health. In such circumstances, we must Authorize the Healthcare Services. Non-emergent follow-up care outside of New Mexico is not Covered for your convenience or preference. You are responsible for any such charges that we do not Authorize. Follow-up care from an Out-of-network Practitioner/Provider requires our Prior Authorization.

Healthcare Services. If you are admitted as an Inpatient to the Hospital, you or your Practitioner needs to notify us as soon as possible so we can review your Hospital stay. We will not deny a claim for Emergency Health services when the Member was referred to the emergency room by his or her PCP or by our representative. If your Emergency Health services results in a hospitalization directly from the emergency room, you are responsible for paying the Inpatient Hospital Cost Sharing amounts (Deductible, Coinsurance and/or Copayment) rather than the emergency room visit Copayment. Refer to your Summary of Benefits and Coverage for the required Cost SharingSharing amount. For Emergency Healthcare Services received Out-of-network and/or outside of New Mexico (our Service Area), you may seek Emergency Healthcare Services from the nearest appropriate facility where Emergency Healthcare Services can be rendered. Non-emergent follow-up care received outside of New Mexico is not Covered unless transfer to an In-network Practitioner/Provider would be medically inappropriate and a risk to your health. In such circumstances, we must Authorize the Healthcare Services. Non-emergent follow-up care outside of New Mexico is not Covered for your convenience or preference. You are responsible for any such charges that we do not Authorize. Follow-up care from an Out-of-network Practitioner/Provider requires our Prior Authorization.