Service Exclusions and Limitations. Any costs incurred for excluded services will be the participant’s responsibility. The following services or items are not covered by LIFE: • Cosmetic surgery unless required for improved functioning of a malformed part of the body resulting from an accidental injury or for reconstruction following cancer surgery. • Any services rendered outside of the United States excluding those described in section VI. • Experimental medical, surgical, or other health procedures.
Service Exclusions and Limitations. Any service which has not been authorized by the Interdisciplinary Team, even if it is listed as a covered benefit, unless for emergency care.
Service Exclusions and Limitations. A. Any service which has not been authorized by the Interdisciplinary Team, except for emergency care. If you or your representative disagrees with the Interdisciplinary Team’s decision not to authorize an item or service, you have the right to appeal. Refer to section XV for a description of the Appeal process.
B. Services rendered in a non-emergency setting or for a non-emergency reason without Trinity Health LIFE New Jersey’s authorization. Trinity Health LIFE New Jersey will pay for coverage of services that are not pre-approved for urgently needed out-of-network services where Trinity Health LIFE New Jersey did not respond to a request for approval within one hour after being contacted or could not be contacted for approval.
C. In an inpatient facility, private room and private duty nursing services (unless medically necessary), and nonmedical items for personal convenience such as telephone charges and radio or television rental (unless specifically authorized by the Interdisciplinary Team as part of the plan of care).
D. Experimental medical, surgical, or other health procedures.
E. Cosmetic surgery unless required for improved functioning of a malformed part of the body resulting from an accidental injury or for reconstruction following cancer surgery.
F. Any services rendered outside of the United States excluding the following: In accordance with §424.122 and §424.124 of the Code of Federal Regulations Title 42, and as permitted under the States approved Medicaid plan. See Guidelines below:
Service Exclusions and Limitations. 1. Any service which has not been authorized by the Interdisciplinary Team, even if it is listed as a covered benefit, unless for emergency care or certain urgent care services.
2. Services rendered in a non-emergency setting or for a non-emergency reason without EB ESP authorization, unless urgent care was pre-approved or urgent care was deemed approved because EB ESP failed to respond to a request for approval within one hour after being contacted or could not be contacted.
3. Cosmetic surgery unless required for improved functioning of a malformed part of the body resulting from an accidental injury or for reconstruction following mastectomy.
4. Experimental, medical, surgical or other health treatments or procedures that are otherwise not Medicare covered services and are not generally accepted medical practice in the geographic area, as determined by the EB ESP Medical Director.
5. Care in any hospital other than EB ESP’ contracted hospitals, except for emergency care, unless authorized in advance by the Interdisciplinary Team.
6. Any services rendered outside the United States, with exceptions as authorized. Please contact EB ESP at (000) 000-0000.
7. Services received outside the EB ESP service area, (except for emergency services, authorized urgently needed care, or if EB ESP failed to respond within one hour for a request for authorization of urgently needed care)
8. Personal comfort items provided such as: private room and private duty nurse, unless medically necessary and any non-medical items for your use such as telephone charges or TV rental.
Service Exclusions and Limitations. Any service which has not been authorized by the Interdisciplinary Team, even if it is listed as a covered benefit, unless for emergency care or certain urgent care services. Services rendered in a non-emergency setting or for a non-emergency reason without ESP of HHSI authorization, unless urgent care was pre-approved or urgent care was deemed approved because ESP of HHSI failed to respond to a request for approval within one hour after being contacted or could not be contacted. Cosmetic surgery unless required for improved functioning of a malformed part of the body resulting from an accidental injury or for reconstruction following mastectomy. Experimental, medical, surgical or other health treatments or procedures that are otherwise not Medicare covered services and are not generally accepted medical practice in the geographic area, as determined by the ESP of HHSI Medical Director. Care in any hospital other than ESP of HHSI’ contracted hospitals, except for emergency care, unless authorized in advance by the Interdisciplinary Team. Any services rendered outside the United States, with exceptions. Please contact ESP of HHSI at 000-000-0000. Services received outside the ESP of HHSI service area, (except for emergency or authorized urgently needed care). Personal comfort items provided such as: private room and private duty nurse, unless medically necessary and any non-medical items for your use such as telephone charges or TV rental.
Service Exclusions and Limitations. Exclusions and Limitations include: Any service not authorized by the Team, unless it is an Emergency Service. You may be fully and personally liable for the costs of unauthorized services. Surgery primarily for cosmetic purposes, unless necessary for improved functioning of a malformed part of your body resulting from an accidental injury or for reconstruction following mastectomy. Experimental medical, surgical, or other health procedures unless authorized by the Team. Any services rendered outside of the United States defined as the 50 states of the U.S., the District of Columbia, and the U.S. territories (Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands) o In the event that a Canadian or Mexican hospital is closer than a U.S. hospital TRU PACE may pay for certain types of health care and services. o If you are crossing through Canada without delay on the most direct route between Alaska and another state and have a medical emergency.
Service Exclusions and Limitations. (a) We are not obliged to provide any service or product not expressly described as forming part of the Service in this Service Schedule.
(b) If the Internet service at the Service Use Address is not functioning, such that a connection cannot be established between your devices being recorded and our recorder, the Service will not function.
(c) The number of concurrent sessions that may be recorded using the Service is limited by the amount of available uncongested bandwidth on the Internet service at the Service Use Address. You acknowledge that the Service may require as much as 100Kbps of uncongested upstream and downstream bandwidth for each session to be recorded. The Internet service at the Service Use Address must be suitably scaled to support the number of concurrent sessions you require.
(d) The Service must not be acquired or used for illegal and unauthorised recording.
(e) We reserve the right to vary any method of supplying the Service provided that the Service substantially conforms to the specifications outlined in this Service Schedule.
Service Exclusions and Limitations. A. Experimental medical, surgical, or other health procedures.
Service Exclusions and Limitations. The Service does not support collect calls, third party billing calls, calling cards or 900 calls. The Service may not support 311, 511 and/or other x11 Service (other than certain specified dialing such as 911 and 411, which are provided for elsewhere in this Agreement) in one or more (or all) service areas.
