Precertification Requests Involving Emergency Care Sample Clauses

Precertification Requests Involving Emergency Care. If you are admitted to the Hospital for Emergency Care and there is not time to obtain Precertification, you will not be subject to the Precertification "penalty" (if any) outlined in your policy if you or your Provider notifies the Plan within two working days following your emergency admission. In addition to Inpatient facility services, some Outpatient services (such as Home Health Care) are also subject to Precertification. If you fail to request Precertification approval, or to abide by the Plan's determination regarding these services, your Benefits will be denied or ..reduced, as set forth in the Covered Health Care Services section of this policy. Please keep in mind that any treatment you receive which is not a Covered Service under this policy, or which is not Medically Necessary, will be excluded from your Benefits. This applies even if Precertification approval is requested or received.
Sample 1
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Precertification Requests Involving Emergency Care. If you are admitted to the Hospital for Emergency Care and there is not time to obtain Precertification, you will not be subject to the Precertification “penalty” (if any) outlined in your Contract if you or your Provider notifies the Plan within two working days following your emergency admission. In addition the Inpatient facility services, some Outpatient services (such as Home Health Care and Hospice) are also subject to Precertification. If you fail to request Precertification approval, or to abide by the Plan’s determination regarding these services, your Benefits will be denied or reduced, as set forth in the Covered Health Care Services section of this Contract.
Sample 1

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