Requesting a Standing Referral Sample Clauses

Requesting a Standing Referral. Members with (i) a Life-Threatening or Seriously Debilitating Condition or (ii) a degenerative and disabling condition or disease, either of which requires specialized medical care over a prolonged period of time may request that a Specialist or Specialty Care Center assume responsibility for providing or coordinating the Member's medical care, including primary and specialty care. A Member may make this request through the Member's PCP or Specialist. The Member or Physician will be sent a form to be completed and returned to the HMO for review. If HMO, or the PCP, in consultation with an HMO medical director and Specialist, if any, determines that the Member's care would most appropriately be coordinated by a Specialist or Specialty Care Center, PCP will authorize a Standing Referral to such Specialist or Specialty Care Center for up to 12 months. Such determination will be made within 3 business days of the date that all appropriate medical records and other items of information necessary to make the determination are provided and, once a determination is made the Referral shall be issued within 4 business days. Any authorized Referral shall be made pursuant to a treatment plan approved by HMO in consultation with the PCP (if appropriate), the Specialist or Specialty Care Center, the Member or the Member's designee. The approved Specialist or Specialty Care Center will be permitted to treat the Member without further Referral from the Member's PCP and may authorize such Referrals, procedures, tests and other Medical Services as the Member's PCP would otherwise be permitted to provide or authorize, subject to the terms of the treatment plan. For the purposes of this coverage, a Specialty Care Center means only centers that are accredited or designated by an agency of the state or federal government or by a voluntary national health organization as having expertise in treating the Life-Threatening or Seriously Debilitating Condition for which it is accredited or designated. Members will receive Standing Referrals to an Appropriately Qualified Specialist within the PCP’s affiliated Medical Group if available, or to an Appropriately Qualified Participating Specialist within the Aetna Value Network, if available. If there are no Appropriately Qualified Participating Specialists within the Aetna Value Network, Member will receive a Standing Referral to an Appropriately Qualified Participating Specialist who is not part of the Aetna Value Network. HMO is not re...
Sample 1
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Requesting a Standing Referral. Member with (i) a life-threatening condition or disease or (ii) a degenerative and disabling condition or disease, either of which requires specialized medical care over a prolonged period of time may request that a Participating Specialist or Participating Specialty Care Center assume responsibility for providing or coordinating the Member’s medical care, including primary and specialty care. A Member may make this request through the Member’s selected PCP. If HMO, or the PCP, in consultation with an HMO medical director and Specialist, if any, determines that the Member’s care would most appropriately be coordinated by a Participating Specialist or Participating Specialty Care Center, PCP will authorize a Standing Referral to such Participating Specialist or Participating Specialty Care Center. Any authorized Referral shall be made pursuant to a treatment plan approved by HMO in consultation with the PCP, the Participating Specialist or Participating Specialty Care Center, the Member or the Member’s designee. The approved Participating Specialist or Participating Specialty Care Center will be permitted to treat the Member without further Referral from the Member’s PCP and may authorize such Referrals, procedures, tests and other Medical Services as the Member’s PCP would otherwise be permitted to provide or authorize, subject to the terms of the treatment plan. The Participating Specialist or Participating Specialty Care Center must refer the Member back to the PCP for primary care services.
Sample 1

Related to Requesting a Standing Referral

  • Local Negotiating Committee (a) A negotiating committee of four (4) employee representatives appointed by the union including the bargaining unit president.

  • Notice of Dispute The party wishing to commence the dispute resolution process must give written notice (Notice of Dispute) to the other parties of:

  • Central Negotiating Team In central bargaining between the Ontario Nurses' Association and the Participating Hospitals, a nurse serving on the Union's Central Negotiating Team shall be paid for time lost from the nurse's regularly scheduled straight time working hours at her or his regular rate of pay, and without loss of leave credits, for attending central negotiating meetings with the Hospitals' Central Negotiating Committee up to, but not including, arbitration. Central Negotiating Team members shall receive unpaid time off for the purpose of preparation for negotiations. The Union will advise the Hospitals concerned, as far in advance as possible, of the dates for which leave is being requested. Upon reference to arbitration, the Central Negotiating Team members shall receive unpaid time off for the purpose of attending arbitration hearings.

  • Arbitration Request If a Party intends to begin an arbitration to resolve a dispute arising under this Agreement, such Party shall provide written notice (the “Arbitration Request”) to the other Party of such intention and the issues for resolution.

  • Dispute Notice If there is a dispute between the parties, then either party may give a notice to the other succinctly setting out the details of the dispute and stating that it is a dispute notice given under this clause 17.1.

  • Sending a Claim Notice Before beginning a lawsuit, mediation or arbitration, you and we agree to send a written notice (a claim notice) to each party against whom a claim is asserted, in order to provide an opportunity to resolve the claim informally or through mediation. Go to xxxxxxxxxxxxxxx.xxx/ claim for a sample claim notice. The claim notice must describe the claim and state the specific relief demanded. Notice to you may be provided by your billing statement or sent to your billing address. Notice to us must include your name, address and Account number and be sent to American Express ADR c/o CT Corporation System, 00 Xxxxxxx Xxxxxx, Xxx Xxxx, Xxx Xxxx 00000. If the claim proceeds to arbitration, the amount of any relief demanded in a claim notice will not be disclosed to the arbitrator until after the arbitrator rules.

  • ARBITRATION NOTICE BY INITIALING IN THE SPACE BELOW YOU ARE AGREEING TO HAVE ANY DISPUTE ARISING OUT OF THE MATTERS INCLUDED IN THE "ARBITRATION OF DISPUTES" PROVISION DECIDED BY NEUTRAL ARBITRATION AS PROVIDED BY CALIFORNIA LAW AND YOU ARE GIVING UP ANY RIGHTS YOU MIGHT POSSESS TO HAVE THE DISPUTE LITIGATED IN COURT OR JURY TRIAL. BY INITIALING IN THE SPACE BELOW YOU ARE GIVING UP YOUR JUDICIAL RIGHTS TO DISCOVERY AND APPEAL, UNLESS SUCH RIGHTS ARE SPECIFICALLY INCLUDED IN THE "ARBITRATION OF DISPUTES" PROVISION. IF YOU REFUSE TO SUBMIT TO ARBITRATION AFTER AGREEING TO THIS PROVISION, YOU MAY BE COMPELLED TO ARBITRATE UNDER THE AUTHORITY OF THE CALIFORNIA CODE OF CIVIL PROCEDURE. YOUR AGREEMENT TO THIS ARBITRATION PROVISION IS VOLUNTARY. WE HAVE READ AND UNDERSTAND THE FOREGOING AND AGREE TO SUBMIT DISPUTES ARISING OUT OF THE MATTERS INCLUDED IN THE "ARBITRATION OF DISPUTES" PROVISION TO NEUTRAL ARBITRATION. Agency Agency-Assisted Contractor

  • Union Negotiating Committee (a) The Employer shall recognize a Union Negotiating Committee that may include, as determined by the Union:

  • Resolution of Disagreements Disputes arising under this Agreement will be resolved informally by discussions between Agency Points of Contact, or other officials designated by each agency.

  • Notification of Dispute If You or We consider that a dispute has arisen in relation to this agreement (either during the Services, or after they have been completed), written notice of the dispute will be given to the other party. Even if that notice is given, You and We must continue to perform any obligations outstanding by Us under the agreement.

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