Post-Stabilization Services. Contractor shall cover Post-Stabilization Services provided by an Affiliated or non-Affiliated Provider in any of the following situations: (i) Contractor authorized such services; (ii) such services were administered to maintain the Enrollee’s Stabilized condition within one (1) hour after a request to Contractor for authorization of further Post-Stabilization Services; or (iii) Contractor does not respond to a request to authorize further Post-Stabilization Services within one (1) hour, Contractor could not be contacted, or Contractor and the treating Provider cannot reach an agreement concerning the Enrollee’s care and an Affiliated Provider is unavailable for a consultation, in which case the treating Provider must be permitted to continue the care of the Enrollee until an Affiliated Provider is reached and either concurs with the treating Provider’s plan of care or assumes responsibility for the Enrollee’s care.
Appears in 5 contracts
Samples: Contract for Health Services, Contract for Health Services, Contract for Health Services
Post-Stabilization Services. The Contractor shall cover Post-Stabilization Services provided by an Affiliated or non-Affiliated Provider in any of the following situations: (ia) the Contractor authorized such services; (iib) such services were administered to maintain the Enrollee’s Stabilized 's stabilized condition within one (1) hour after of a request to the Contractor for authorization of further Post-Stabilization Services; or (iiic) the Contractor does not respond to a request to authorize further Post-Stabilization Services within one (1) hour, the Contractor could not be contacted, or the Contractor and the treating Provider cannot reach an agreement concerning the Enrollee’s 's care and an Affiliated Provider is unavailable for a consultation, in which case the treating Provider must be permitted to continue the care of the Enrollee until an Affiliated Provider is reached and either concurs with the treating Provider’s 's plan of care or assumes responsibility for the Enrollee’s 's care.
Appears in 5 contracts
Samples: Contract for Furnishing Health Services by a Managed Care Organization (Wellcare Health Plans, Inc.), Contract for Furnishing Health Services (Wellcare Health Plans, Inc.), Contract for Furnishing Health Services (Wellcare Health Plans, Inc.)
Post-Stabilization Services. The Contractor shall cover Post-Stabilization Services provided by an Affiliated or a non-Affiliated Provider in any of the following situations: situations:
(i1) the Contractor authorized such services; ;
(ii2) such services were administered to maintain the Enrollee’s Stabilized stabilized condition within one (1) hour after of a request to the Contractor for authorization of further Post-Stabilization Services; or or
(iii3) the Contractor does not respond to a request to authorize further Post-Post- Stabilization Services within one (1) hour, the Contractor could not be contacted, or the Contractor and the treating Provider cannot reach an agreement concerning the Enrollee’s care and an Affiliated Provider is unavailable for a consultation, in which case the treating Provider must be permitted to continue the care of the Enrollee until an Affiliated Provider is reached and either concurs with the treating Provider’s plan of care or assumes responsibility for the Enrollee’s care.
Appears in 1 contract
Samples: Contract for Furnishing Health Services by a Managed Care Organization