Common use of Hospital Services — Outpatient Clause in Contracts

Hospital Services — Outpatient. a. Outpatient Hospital services consist of preventive, diagnostic, therapeutic or palliative care under the direction of a physician or dentist at a licensed acute care Hospital. Outpatient Hospital services include Medically Necessary emergency room services, dressings, splints, oxygen and physician ordered services and supplies for the clinical treatment of a specific diagnosis or treatment. a. The Health Plan shall provide outpatient Hospital services and Emergency Services and Care as Medically Necessary and appropriate and without any specified dollar limitations. b. The Health Plan shall have a procedure for the authorization of dental care and associated ancillary medical services provided in an outpatient Hospital setting if that care meets the following requirements: (1) Is provided under the direction of a dentist at a licensed Hospital; and (2) Is Medically Necessary; or (3) The Health Plan shall pay for any Medically Necessary duration of stay in a noncontracted facility which results from a medical emergency, until such time as the Health Plan can safely transport the Enrollee to a participating facility.