Timely Treatment Clause Samples

Timely Treatment. Timely treatment by providers, such that the participant shall be seen by a provider in accordance with the following: A. Emergency care shall be provided immediately; B. Urgently needed care shall be provided within twenty-four (24) hours; C. Routine care of patients who do not require emergency or urgently needed care shall be provided within seven (7) calendar days; D. Follow-up care shall be provided as medically appropriate. For the purposes of this section, the following definitions shall apply: Emergency care is that required for the treatment of an injury or acute illness that, if not treated immediately, could reasonably result in serious or permanent damage to the patient's health. Urgently needed care is that required within a twenty-four (24) hour period to prevent a condition from requiring emergency care. Routine care is that level of care that can be delayed without anticipated deterioration in the patient's medical condition for a period of seven (7) calendar days. By utilization of the foregoing standards, FHKC does not intend to create standards of care or access different from those that are deemed acceptable within HEALTH PLAN service area. Rather FHKC intends that the provider timely and appropriately respond to patient care needs, as they are presented, in accordance with standards of care existing within the service area. In applying the foregoing standards, the provider shall give due regard to the level of discomfort and anxiety of the patient and/or parent. In the event FHKC determines that HEALTH PLAN, or its providers, has failed to meet the access standards herein set forth, FHKC shall provide HEALTH PLAN with written notice of non-compliance. Such notice can be provided via facsimile or other means, specifying the failure in such detail as will reasonably allow HEALTH PLAN to investigate and respond. Failure of HEALTH PLAN to obtain reasonable compliance or acceptable community care under the following conditions shall constitute a breach of this agreement: A. immediately upon receipt of notice for emergency or urgent problem; or B. within ten (10) days of receipt of notice for routine visit access. Such breach shall entitle FHKC to such legal and equitable relief as may be appropriate. In particular, FHKC may direct its participants to obtain such services outside HEALTH PLAN HEALTH PLANS Effective Dates: October 1, 2003 - September 30, 2005 Page 40 of 50 provider network as specified in Section 3-2-1 of this Agreement. HEALT...