Urgently Needed Services. Covered Services required in order to prevent a serious deterioration of an HMO Member’s health that results from an unforeseen illness or injury if (i) such Member is temporarily absent from the Service Area and (ii) receipt of the health care service cannot be delayed until the Member’s return to the Service Area.
Urgently Needed Services a) The Contractor is responsible for Urgently Needed Services.
b) Urgently Needed Services are covered only in the United States, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the Northern Mariana Islands and Canada.
c) The Contractor must disclose to all Enrollees the procedures to be followed to obtain Urgently Needed Services.
Urgently Needed Services. Payor shall pay for all Covered Services constituting Urgently Needed Services rendered to a Member. [42 C.F.R. § 422.100(b).]
Urgently Needed Services. Urgently Needed Services are defined as those services that are provided to you when: You are absent from the PACE CNY service area And You believe that the care cannot wait until you return to the PACE CNY service area, but the condition does not put your life or function in danger.
Urgently Needed Services those Covered Services provided when an enrollee is temporarily absent from Plan's service (or if applicable, continuation) area (or, for unusual or extraordinary circumstances, provided when the enrollee is in the service or continuation area but Plan's provider network is temporarily unavailable or inaccessible) when such services are Medically Necessary and immediately required; (1) as a result of an unforeseen illness, injury, or condition; and (2) it was not reasonable given the circumstances to obtain the services through Plan.
Urgently Needed Services. Covered Services that are not Emergency Services, provided when a Member is temporarily absent from the licensed service area (or, if applicable, Continuation Area) (or provided when a Member is in the licensed service area or Continuation Area, but Cigna-HealthSpring’s provider network is temporarily unavailable or inaccessible) when such services are Medically Necessary and immediately required as a result of an unforeseen illness, injury, or condition, and it was not reasonable given the circumstances to obtain the services from a Cigna-HealthSpring Participating Provider. [42 C.F.R. § 422.113(b)(1)(iii).]
Urgently Needed Services. Cigna-HealthSpring shall pay for all Covered Services constituting Urgently Needed Services rendered to a Member. [42 C.F.R. § 422.100(b).]
Urgently Needed Services. Contracted Services, that are not Emergency Services, provided when a MA Member is temporarily absent from MA HEALTH PLAN’s service (or continuation) area (or, under unusual and extraordinary circumstances, provided when the MA Member is in MA HEALTH PLAN’s service or continuation area but MA HEALTH PLAN’s provider network is temporarily unavailable or inaccessible) when the services are Medically Necessary and immediately required (a) as a result of an unforeseen illness, injury or condition; and (b) it was not reasonable given the circumstances to obtain the services through MA HEALTH PLAN.
Urgently Needed Services. Urgently Needed Services are defined as those services, which require immediate medical attention due to unexpected illness and injury. If out of area, urgent care may be required when an illness or injury is too severe to postpone treatment until return- ing to the service area, but life or function is not in severe jeopardy. Nurses are available Monday through Friday 8:00 AM to 4:30 PM. During off-hours, weekends or holidays, an on-call nurse may be contacted. The nurse may contact the primary care physician who will advise or make the necessary arrangements for the care needed. Should Eddy SeniorCare not respond to your concern within 1 hour you may go to any healthcare provider and Eddy SeniorCare assumes responsibility for the cost of care. Fevers, abdominal pain, nausea and vomiting and difficulty urinating are some exam- ples of urgently needed service situations. Eddy SeniorCare covers urgently needed services both in and out of the service area when such services are necessary and im- mediately required. When emergency care, post stabilization care, or urgent care has been provided, the doctor or hospital that provided such services may xxxx you. Forward any bills re- ceived to Eddy SeniorCare for processing and keep a copy for your records.
Urgently Needed Services. Covered Medical Services provided when a Medicare+Choice Member is temporarily absent from the RPO Service Area (or, if applicable, Continuation Area) (or, under unusual and extraordinary circumstances, provided when a Medicare+Choice Member is in the RPO Service Area or Continuation Area, but Texas HealthSpring's provider network is temporarily unavailable or inaccessible) when such services are Medically Necessary and required without delay in order to prevent the serious deterioration of a Medicare+Choice Member's health as a result of an unforeseen illness, injury, or condition and it was not reasonable given the circumstances to obtain the services through Texas HealthSpring.
