Common use of Payment Liability for Emergency Services Clause in Contracts

Payment Liability for Emergency Services. (A) An Enrollee who has had an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose or stabilize the specific condition. (B) When the Enrollee has an Emergency Medical Condition, the Contractor shall pay for both the screening examination and the services required to stabilize the Enrollee. Services required to stabilize an Enrollee includes all Emergency Services that are Medically Necessary to assure, within reasonable medical probability, that no material deterioration of the Enrollee’s condition is likely to result from, or occur during, discharge of the Enrollee or transfer of the Enrollee to another facility. (C) If there is a disagreement between a hospital Provider and the Contractor concerning whether the Enrollee is stable enough for discharge or transfer, or whether the medical benefits of a transfer outweighs the risks, the judgment of the attending physician(s) actually caring for the Enrollee at the treating facility prevails and is binding on the Contractor. The Contractor may establish arrangements with hospitals whereby the Contractor may send one if its own physicians with appropriate privileges to assume the attending physician’s responsibilities to stabilize, treat, and transfer the Enrollee.

Payment Liability for Emergency Services. (A) An Enrollee who has had an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or stabilize the specific conditionpatient. (B) When the Enrollee has an Emergency Medical Condition, the Contractor shall pay for both the screening examination and the services required to stabilize the Enrollee. Services required to stabilize an Enrollee includes all Emergency Services emergency services that are Medically Necessary to assure, within reasonable medical probability, that no material deterioration of the Enrollee’s condition is likely to result from, or occur during, discharge of the Enrollee or transfer of the Enrollee to another facility. (C) If there is a disagreement between a hospital Provider and the Contractor concerning whether the Enrollee is stable enough for discharge or transfer, or whether the medical benefits of a an unstabilized transfer outweighs the risks, the judgment of the attending physician(s) actually caring for the Enrollee at the treating facility prevails and is binding on the Contractor. The Contractor may establish arrangements with hospitals whereby the Contractor may send one if its own physicians with appropriate ER privileges to assume the attending physician’s responsibilities to stabilize, treat, and transfer the Enrollee.

Payment Liability for Emergency Services. (A) An Enrollee who has had an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or stabilize the specific conditionEnrollee. (B) When the Enrollee has an Emergency Medical Condition, the Contractor shall pay for both the screening examination and the treatment services required to stabilize the Enrollee. Services required to stabilize an Enrollee includes all Emergency Services that are Medically Necessary to assure, within reasonable medical probability, that no material deterioration of the Enrollee’s condition is likely to result from, or occur during, discharge of the Enrollee or transfer of the Enrollee to another facility. (C) If there is a disagreement between a hospital Provider and the Contractor concerning whether the Enrollee is stable enough for discharge or transfer, or whether the medical benefits of a an unstabilized transfer outweighs the risks, the judgment of the attending physician(s) actually caring for the Enrollee at the treating facility prevails and is binding on the Contractor. The Contractor may establish arrangements with hospitals whereby the Contractor may send one if its own physicians with appropriate privileges to assume the attending physician’s responsibilities to stabilize, treat, and transfer the Enrollee.

Payment Liability for Emergency Services. (A) An Enrollee who has had an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or stabilize the specific conditionpatient. (B) When the Enrollee has an Emergency Medical Condition, the Contractor shall pay for both the screening examination and the services required to stabilize the Enrollee. Services required to stabilize an Enrollee enrollee includes all Emergency Services emergency services that are Medically Necessary to assure, within reasonable medical probability, that no material deterioration of the Enrollee’s condition is likely to result from, or occur during, discharge of the Enrollee or transfer of the Enrollee to another facility. (C) If there is a disagreement between a hospital Provider and the Contractor concerning whether the Enrollee is stable enough for discharge or transfer, or whether the medical benefits of a an unstabilized transfer outweighs the risks, the judgment of the attending physician(s) actually caring for the Enrollee at the treating facility prevails and is binding on the Contractor. The Contractor may establish arrangements with hospitals whereby the Contractor may send one if its own physicians with appropriate ER privileges to assume the attending physician’s responsibilities to stabilize, treat, and transfer the Enrollee. (D) In the event an Enrollee presents to an Emergency Room with both a physical health and mental health diagnosis, and the Enrollee requires medical stabilization, the Contractor shall pay for the facility charge and any ancillary services for the entire Emergency Room visit.

Payment Liability for Emergency Services. (A) An Enrollee who has had an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or stabilize the specific conditionpatient. (B) When the Enrollee has an Emergency Medical Condition, the Contractor shall pay for both the screening examination and the services required to stabilize the Enrollee. Services required to stabilize an Enrollee enrollee includes all Emergency Services emergency services that are Medically Necessary to assure, within reasonable medical probability, that no material deterioration of the Enrollee’s condition is likely to result from, or occur during, discharge of the Enrollee or transfer of the Enrollee to another facility. (C) If there is a disagreement between a hospital Provider and the Contractor concerning whether the Enrollee is stable enough for discharge or transfer, or whether the medical benefits of a an unstabilized transfer outweighs the risks, the judgment of the attending physician(s) actually caring for the Enrollee at the treating facility prevails and is binding on the Contractor. The Contractor may establish arrangements with hospitals whereby the Contractor may send one if its own physicians with appropriate emergency department privileges to assume the attending physician’s responsibilities to stabilize, treat, and transfer the Enrollee.

Payment Liability for Emergency Services. (A) An Enrollee who has had an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or stabilize the specific conditionEnrollee. (B) When the Enrollee has an Emergency Medical Condition, the Contractor shall pay for both the screening examination and the services required to stabilize the Enrollee. Services required to stabilize an Enrollee includes all Emergency Services emergency services that are Medically Necessary to assure, within reasonable medical probability, that no material deterioration of the Enrollee’s condition is likely to result from, or occur during, discharge of the Enrollee or transfer of the Enrollee to another facility. (C) If there is a disagreement between a hospital Provider and the Contractor concerning whether the Enrollee is stable enough for discharge or transfer, or whether the medical benefits of a an unstabilized transfer outweighs the risks, the judgment of the attending physician(s) actually caring for the Enrollee at the treating facility prevails and is binding on the Contractor. The Contractor may establish arrangements with hospitals whereby the Contractor may send one if its own physicians with appropriate emergency department privileges to assume the attending physician’s responsibilities to stabilize, treat, and transfer the Enrollee. (D) In the event an Enrollee presents to an Emergency Room, the Contractor shall pay for the facility charge and any ancillary services for the entire Emergency Room visit.

Payment Liability for Emergency Services. (A) An Enrollee who has had an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or stabilize the specific conditionEnrollee. (B) When the Enrollee has an Emergency Medical Condition, the Contractor shall pay for both the screening examination and the services required to stabilize the Enrollee. Services required to stabilize an Enrollee includes all Emergency Services that are Medically Necessary to assure, within reasonable medical probability, that no material deterioration of the Enrollee’s condition is likely to result from, or occur during, discharge of the Enrollee or transfer of the Enrollee to another facility. (C) If there is a disagreement between a hospital Provider and the Contractor concerning whether the Enrollee is stable enough for discharge or transfer, or whether the medical benefits of a an unstabilized transfer outweighs the risks, the judgment of the attending physician(s) actually caring for the Enrollee at the treating facility prevails and is binding on the Contractor. The Contractor may establish arrangements with hospitals whereby the Contractor may send one if its own physicians with appropriate emergency department privileges to assume the attending physician’s responsibilities to stabilize, treat, and transfer the Enrollee.

Payment Liability for Emergency Services. (A) An Enrollee who has had an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose or stabilize the specific condition. (B) When the Enrollee has an Emergency Medical Condition, the Contractor shall pay for both the screening examination and the services required to stabilize the Enrollee. Services required to stabilize an Enrollee includes all Emergency Services that are Medically Necessary to assure, within reasonable medical probability, that no material deterioration of the Enrollee’s condition is likely to result from, or occur during, discharge of the Enrollee or transfer of the Enrollee to another facility. (C) If there is a disagreement between a hospital Provider and the Contractor concerning whether the Enrollee is stable enough for discharge or transfer, or whether the medical benefits of a transfer outweighs the risks, the judgment of the attending physician(s) actually caring for the Enrollee at the treating facility prevails and is binding on the Contractor. The Contractor may establish arrangements with hospitals whereby the Contractor may send one if its own physicians with appropriate privileges to assume the attending physician’s responsibilities to stabilize, treat, and transfer the Enrollee.

Payment Liability for Emergency Services. (A) An Enrollee who has had an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or stabilize the specific conditionEnrollee. (B) When the Enrollee has an Emergency Medical Condition, the Contractor shall pay for both the screening examination and the services required to stabilize the Enrollee. Services required to stabilize an Enrollee includes all Emergency Services emergency services that are Medically Necessary to assure, within reasonable medical probability, that no material deterioration of the Enrollee’s condition is likely to result from, or occur during, discharge of the Enrollee or transfer of the Enrollee to another facility. (C) If there is a disagreement between a hospital Provider and the Contractor concerning whether the Enrollee is stable enough for discharge or transfer, or whether the medical benefits of a an unstabilized transfer outweighs the risks, the judgment of the attending physician(s) actually caring for the Enrollee at the treating facility prevails and is binding on the Contractor. The Contractor may establish arrangements with hospitals whereby the Contractor may send one if its own physicians with appropriate emergenct department privileges to assume the attending physician’s responsibilities to stabilize, treat, and transfer the Enrollee.

Payment Liability for Emergency Services. (A) An Enrollee who has had an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose or stabilize the specific condition. (B) When the Enrollee has an Emergency Medical Condition, the Contractor shall pay for both the screening examination and the services required to stabilize the Enrollee. Services required to stabilize an Enrollee includes all Emergency Services that are Medically Necessary to assure, within reasonable medical probability, that no material deterioration of the Enrollee’s condition is likely to result from, or occur during, discharge of the Enrollee or transfer of the Enrollee to another facility. (C) If there is a disagreement between a hospital Provider and the Contractor concerning whether the Enrollee is stable enough for discharge or transfer, or whether the medical benefits of a transfer outweighs the risks, the judgment of the attending physician(s) actually caring for the Enrollee at the treating facility prevails and is binding on the Contractor. The Contractor may establish arrangements with hospitals whereby the Contractor may send one if its own physicians with appropriate privileges to assume the attending physician’s responsibilities to stabilize, treat, and transfer the Enrollee. (D) In the event an Enrollee presents to an emergency room, the Contractor shall pay for the facility charge and any ancillary services for the entire Emergency Room visit.

Payment Liability for Emergency Services. (A) An Enrollee who has had an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or stabilize the specific conditionpatient. (B) When the Enrollee has an Emergency Medical Condition, the Contractor shall pay for both the screening examination and the services required to stabilize the Enrollee. Services required to stabilize an Enrollee enrollee includes all Emergency Services emergency services that are Medically Necessary to assure, within reasonable medical probability, that no material deterioration of the Enrollee’s condition is likely to result from, or occur during, discharge of the Enrollee or transfer of the Enrollee to another facility. (C) If there is a disagreement between a hospital Provider and the Contractor concerning whether the Enrollee is stable enough for discharge or transfer, or whether the medical benefits of a an unstabilized transfer outweighs the risks, the judgment of the attending physician(s) actually caring for the Enrollee at the treating facility prevails and is binding on the Contractor. The Contractor may establish arrangements with hospitals whereby the Contractor may send one if of its own physicians with appropriate ER privileges to assume the attending physician’s responsibilities to stabilize, treat, and transfer the Enrollee.