Common use of PLEASE NOTE Clause in Contracts

PLEASE NOTE. You do not need preauthorization for emergency services. Additionally, you do not need preauthorization from us or from any other person (including a PCP) in order to obtain access to obstetrical or gynecological care from a network physician who specializes in obstetrics or gynecology. Your physician, however, may be required to comply with certain procedures, including obtaining preauthorization for certain services. Expedited Preauthorization You may request an expedited preauthorization review in an emergency. We will respond to you with a determination within seventy-two (72) hours following receipt of the request. Concurrent Authorization We review requests for concurrent authorization when you need an extension of an authorized course of treatment beyond the period of time or number of treatments already approved. If we deny your request, we will notify your provider before the end of the treatment period and will let you know within twenty-four (24) hours from receipt of the request if the request is made at least twenty-four (24) hours before the expiration of the period of time or number of treatments. You have the right to appeal our determination or to take legal action as described in this section. Retrospective Authorization We review requests for retrospective authorization when services were provided before authorization was obtained. A notification of the retrospective determination will be provided within thirty (30) calendar days from receipt of the request. You have the right to appeal our determination or to take legal action as described in this section.

PLEASE NOTE. You do not need preauthorization for emergency services. Additionally, you do not need preauthorization from us or from any other person (including a PCP) in order to obtain access to obstetrical or gynecological care from a network physician who specializes in obstetrics or gynecology. Your physician, however, may be required to comply with certain procedures, including obtaining preauthorization for certain services. Expedited Preauthorization You may request an expedited preauthorization review in an emergency. We will respond to you with a determination within seventy-two (72) hours following receipt of the request. Concurrent Authorization We review requests for concurrent authorization when you need an extension of an authorized course of treatment beyond the period of time or number of treatments already approved. If we deny your request, we will notify your provider before the end of the treatment period and will let you know within twenty-four (24) hours from receipt one business day of making the request if the request is made at least twenty-four (24) hours before the expiration of the period of time or number of treatmentsdetermination. You have the right to appeal our determination or to take legal action as described in this section. Retrospective Authorization We review requests for retrospective authorization when services were provided before authorization was obtained. A notification of the retrospective determination will be provided within thirty (30) calendar days from receipt of the request. You have the right to appeal our determination or to take legal action as described in this section.