SECOND OPINION POLICY. It is the policy of CDN that a second opinion obtained from a participating panel provider will be a covered benefit. The covered benefit will need an approval from the Plan. A second opinion is encouraged as a positive component of quality of care.
SECOND OPINION POLICY. A second opinion may be required at Our discretion prior to the scheduling of certain Health Services. We will advise You if a proposed Health Service is subject to the second opinion policy. If so, You must consult with a second Participating Provider prior to the scheduling of the service. You must (1) contact Us to obtain a list of Participating Providers who are authorized to render a second opinion, and (2) arrange a consultation with the second Provider. The second Provider will not be affiliated with the first Provider. You must obtain the second opinion within 31 days of the first opinion or as soon thereafter as is reasonably possible. Second opinions We have arranged as described above are provided at no cost to You. A second opinion may also be obtained at the request of an Enrollee, subject to separate benefit restrictions and/or Copays/Coinsurance described elsewhere in this Contract.
SECOND OPINION POLICY. Coverage of certain Health Services as Network Benefits may require that Covered Persons consult a second Network Physician prior to the scheduling of the Health Service. The Company will notify them that a particular Health Service is subject to a second opinion Policy and will inform them of the required procedure for obtaining a second opinion.
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your PCP, and the IDT. If you desire a second opinion, you should notify your PCP or nurse practitioner. Tuberculosis Testing A tuberculosis (TB) skin test(s) or chest X-ray is required upon enrollment. FHCN PACE will provide treatment if the TB test is positive. Payment for Unauthorized Services You may be fully and personally responsible to pay for unauthorized or out-of-PACE-network services, except for Emergency Services and Urgent Care (see “Reimbursement Provisions” in CHAPTER 5). Payment for Services under this Enrollment Agreement Payment for services provided under this Enrollment Agreement will be made by FHCN PACE to the provider. You cannot be required to pay anything that is owed by FHCN PACE to the selected providers. CHAPTER 13 DEFINITION S Benefits and coverage are the health and health-related services we provide through this Enrollment Agreement. These services take the place of the benefits you would otherwise receive through Medicare and/or Medi-Cal. Their provision is made possible through an agreement between FHCN PACE, Medicare (Centers for Medicare and Medicaid Services of the Department of Health and Human Services) and Medi-Cal (Department of Health Care Services). This Enrollment Agreement gives you the same benefits you would receive under Medicare and Medi-Cal plus many additional benefits. To receive any benefits under this Enrollment Agreement, you must meet the conditions described in this Enrollment Agreement.
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your PCP and the IDT. If you desire a second opinion you should notify your PCP or nurse practitioner. {PACE Organization} will issue a decision on second opinions within 72 hours. The timeline is available upon request by calling {insert telephone number here} or contacting {insert name and address of appropriate entity here}. Tuberculosis Testing A tuberculosis (TB) skin test(s) or chest X-ray is required upon enrollment. {PACE Organization} will provide treatment if the TB test is positive. Payment for Unauthorized Services You will be responsible to pay for unauthorized services, except for Emergency Services and Urgent Care (see “Reimbursement Provisions” in CHAPTER 5). Payment for Services under this Enrollment Agreement Payment for services provided under this Enrollment Agreement will be made by {PACE Organization} to the provider. You cannot be required to pay anything that is owed by {PACE Organization} to the selected providers.
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your PCP and the IDT. If you desire a second opinion you should notify your PCP or nurse practitioner. {PACE Organization} will issue a decision on second opinions within 72 hours. The timeline is available upon request by calling {insert telephone number here} or contacting {insert name and address of appropriate entity here}. Standing Referrals Process You may receive a standing referral to a medical specialist if you have HIV or AIDS or if your PCP determines that you need the continuing care of a specialist. Your PCP is responsible for approving a standing referral and will do so in accordance with {PACE Program’s} standing referral procedures. Additional information regarding standing referrals, including a list of specialists with expertise in caring for people with HIV or AIDS is available upon request by contacting your PCP or {list additional contact person or place here} at {insert telephone number here}. Time Limits on Claims Any claim that you may have against {PACE Organization} or with respect to services provided by {PACE Organization} must be brought by you within two years from the date you receive the service for which the claim is brought. In the case of personal injuries, the claim must be brought within one year from the date on which those injuries were sustained. Tuberculosis Testing A tuberculosis skin test(s) or chest X-ray is required prior to enrollment. Waiver of Conditions for Care If you do not meet a certain condition of {PACE Organization} to receive a particular service, we reserve the right to waive such a condition if we, in our judgment, determine that you could medically benefit from receiving that service. However, if we do waive a condition for you in one instance, this does not mean that we are obligated to waive that condition or any other condition for you on any other occasion.
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your Primary Care Physician and the Interdisciplinary Team. If you desire a second opinion you should notify your Primary Care Physician or Nurse Practitioner. {PACE Program} will issue a decision on second opinions within 72 hours. The timeline is available upon request by calling {insert phone # here} or contacting {insert name and address of appropriate entity here}. Standing Referrals Process You may receive a standing referral to a medical specialist if you have HIV or AIDS or if your Primary Care Physician determines that you need the continuing care of a specialist. Your Primary Care Physician is responsible for approving a standing referral and will do so in accordance with {PACE Program’s} standing referral procedures. Additional information regarding standing referrals, including a list of specialists with expertise in caring for people with HIV or AIDS is available upon request by contacting your Primary Care Physician or {list additional contact person or place here} at {insert telephone # here}. Time Limits on Claims Any claim that you may have against {PACE Program} or with respect to services provided by {PACE Program} must be brought by you within two years from the date you receive the service for which the claim is brought. In the case of personal injuries, the claim must be brought within one year from the date on which those injuries were sustained. Tuberculosis Testing A tuberculosis skin test(s) or chest X-ray is required prior to enrollment. Waiver of Conditions for Care If you do not meet a certain condition of {PACE Program} to receive a particular service, we reserve the right to waive such a condition if we, in our judgment, determine that you could medically benefit from receiving that service. However, if we do waive a condition for you in one instance, this does not mean that we are obligated to waive that condition or any other condition for you on any other occasion. Who Pays for Unauthorized Services? You will be responsible to pay for unauthorized services, except for Emergency Services and Urgently Needed Care (see “Reimbursement Provisions” in CHAPTER FIVE). Who Receives Payment Under this Contract? Payment for services provided under this Contract will be made by {PACE Program} to the provider. You cannot be required to pay anything that is owed by {PACE Provider} to the selected providers. CHAPTER THIRTEEN DEFINITIONS Benefit...
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your PCP and the IDT. If you desire a second opinion, you should notify your PCP or nurse practitioner. CalOptima PACE will issue a decision on second opinions within 72 hours. The timeline is available upon request by calling 0-000-000-0000 or contacting: CalOptima PACE 00000 Xxxxxx Xxxxx Xxxx. Garden Grove, CA 92843 Tuberculosis Testing A tuberculosis (TB) skin test(s) or chest X-ray is required upon enrollment. CalOptima PACE will provide treatment if the TB test is positive. Payment for Unauthorized Services You will be responsible to pay for unauthorized services, except for emergency services and urgent care. (See “Reimbursement Provisions” in Chapter 5.)
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your PCP and the IDT. If you desire a second opinion you should notify your PCP or nurse practitioner. GMWP will issue a decision on second opinions within 72 hours. The timeline is available upon request by calling the GMWP Medical Director at at (000) 000-0000 at any time. For the hearing-impaired (TTY/TDD), please call (000) 000-0000. Tuberculosis Testing A tuberculosis (TB) skin test(s) or chest X-ray is required upon enrollment and annually as appropriate. GMWP will provide treatment if the TB test is positive. Payment for Unauthorized Services You will be responsible to pay for unauthorized services, except for Emergency Services and Urgent Care (see “Reimbursement Provisions” in CHAPTER 5). Payment for Services under this Enrollment Agreement Payment for services provided under this Enrollment Agreement will be made by GMWP to the provider. You cannot be required to pay anything that is owed by GMWP to the selected providers.
