Maternity Admissions the minimum length of the inpatient stay is 48 hours for a normal, vaginal delivery or 96 hours for a Cesarean section unless the attending Physician, in consultation with the mother, determines a shorter inpatient stay is adequate. Mastectomy: The length of the inpatient stay is determined post-operatively by the attending Physician in consultation with the Member.
Maternity Admissions the minimum length of the inpatient stay is 48 hours for a normal, vaginal de- livery or 96 hours for a Cesarean section unless the attending Physician, in consultation with the mother, determines a shorter inpatient stay is xxx- xxxxx. Mastectomy: The length of the inpatient stay is de- termined post-operatively by the attending Physi- cian in consultation with the Member. Discharge Planning If further care at home or in another facility is ap- propriate following discharge from the Hospital, Blue Shield or Blue Shield’s MHSA will work with the Member, the attending Physician and the Hospital discharge planners to determine the most appropriate and cost effective way to provide this care.
Maternity Admissions the minimum length of the inpatient stay is 48 hours for a normal, vaginal delivery or 96 hours for a Cesarean section unless the attending Physician, in consultation with the mother, determines a shorter inpatient stay is adequate. Mastectomy: The length of the inpatient stay is determined post-operatively by the attending Physician in consultation with the Member. Necessary, coverage will be denied. For an authorized admission to a Non- Participating Hospital or authorized Non-Routine Outpatient Mental Health Services, Behavioral Health Treatment, and Outpatient Substance Use Disorder Services from a Non-Participating Provider, the Member is responsible for applicable Deductible, Copayment, and Coinsurance amounts and all charges in excess of the Allowable Amount. Prior authorization is not required for an emergency mental health, behavioral health, or substance use disorder Hospital admission; See the Emergency Admission Notification section for additional information. Emergency Admission Notification When a Member is admitted to the Hospital for Emergency Services, Blue Shield or Blue Shield’s MHSA should receive Emergency Admission Notification within 24 hours or as soon as it is reasonably possible following medical stabilization. Inpatient Utilization Management Most inpatient Hospital admissions are monitored for length of stay; exceptions are noted below. The length of an inpatient Hospital stay may be extended or reduced as warranted by the Member’s condition. When a determination is made that the Member no longer requires an inpatient level of care, written notification is given to the attending Discharge Planning If further care at home or in another facility is appropriate following discharge from the Hospital, Blue Shield or Blue Shield’s MHSA will work with the Member, the attending Physician and the Hospital discharge planners to determine the most appropriate and cost effective way to provide this care. Case Management The Benefits Management Program may also include case management, which is a service that provides the assistance of a health care professional to help the Member access necessary services and to make the most efficient use of plan Benefits. The Member’s nurse case manager may also arrange for alternative care benefits to avoid prolonged or repeated hospitalizations, when medically appropriate. Alternative care benefits are only utilized by mutual consent of the Member, the provider, and Blue Shield or Blue Shield’s MHSA, an...
Maternity Admissions. Prior authorization is not required for the 48 hour stay for an uncomplicated vaginal delivery, or the ninety-six (96) hour stay for uncomplicated cesarean section.
Maternity Admissions the minimum length of the inpatient stay is 48 hours for a normal, vaginal de- livery or 96 hours for a Cesarean section unless the attending Physician, in consultation with the mother, determines a shorter inpatient stay is xxx- xxxxx. Mastectomy: The length of the inpatient stay is de- termined post-operatively by the attending Physi- cian in consultation with the Member. vices, including, but not limited to, Behavioral Health Treatment, Partial Hospitalization Program (PHP), Intensive Outpatient Program (IOP), elec- troconvulsive therapy, Office-Based Opioid Treat- ment (OBOT), Psychological Testing, and Xxxx- scranial Magnetic Stimulation (TMS) must also be prior authorized by the MHSA. Discharge Planning If further care at home or in another facility is ap- propriate following discharge from the Hospital, Blue Shield or Blue Shield’s MHSA will work with the Member, the attending Physician and the Hospital discharge planners to determine the most appropriate and cost effective way to provide this care.
Maternity Admissions the minimum length of the inpatient stay is 48 hours for a normal, vaginal delivery or 96 hours for a Cesarean section unless the attending Physician, in consultation with the mother, determines a shorter inpatient stay is adequate. Mastectomy: The length of the inpatient stay is determined post-operatively by the attending Physician in consultation with the Member. Based Opioid Treatment (OBOT), Psychological Testing and Transcranial Magnetic Stimulation (TMS) must also be prior authorized by the MHSA. If prior authorization was not obtained for an inpatient mental health or substance abuse Hospital admission or for any Non-Routine Outpatient Mental Health or Substance Abuse Services and the services provided to the Member are determined not to be a Benefit of the plan, or were not Medically Necessary, coverage will be denied. Discharge Planning If further care at home or in another facility is appropriate following discharge from the Hospital, Blue Shield or Blue Shield’s MHSA will work with the Member, the attending Physician and the Hospital discharge planners to determine the most appropriate and cost effective way to provide this care. For an authorized admission to a Non-Participating Hospital or authorized Non-Routine Outpatient Mental Health and Substance Abuse Services from a Non- Participating Provider, the Member is responsible for applicable Deductible, Copayment and Coinsurance amounts and all charges in excess of the Allowable Amount. Prior authorization is not required for an emergency mental health or substance abuse Hospital admission; See the Emergency Admission Notification section for additional information. Emergency Admission Notification When a Member is admitted to the Hospital for Emergency Services, Blue Shield or Blue Shield’s MHSA should receive Emergency Admission Notification within 24 hours or as soon as it is reasonably possible following medical stabilization.
Maternity Admissions the minimum length of professional to help the Member access necessary services and to make the most efficient use of plan Benefits. The Member’s case manager may also arrange for alternative care benefits to avoid prolonged or repeated hospitalizations, when medically appropriate. Alternative care benefits are only utilized by mutual consent of the Member, the provider, and Blue Shield, and will not exceed the standard Benefits available under this plan. The approval of alternative case benefits is specific to each Member for a specified period of time. Such approval should not be construed as a waiver of Blue Shield’s right to thereafter administer this health plan in strict accordance with its express terms. Blue Shield is not obligated to provide the same or similar alternative care benefits to any other person in any other instance. the inpatient stay is 48 hours for a normal, vaginal delivery or 96 hours for a Cesarean section unless the attending Physician, in consultation with the mother, determines a shorter inpatient stay is adequate. Mastectomy: The length of the inpatient stay is determined post-operatively by the attending Physician in consultation with the Member.
