Common use of While You Are in the Hospital Clause in Contracts

While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital and we will explain the reason(s) behind our decision.

Appears in 2 contracts

Samples: Member Benefit Agreement, Member Benefit Agreement

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While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days days, and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital Hospital who is acting as the Member’s representative during their Inpatient stay, and we will explain the reason(s) behind our decision.

Appears in 2 contracts

Samples: Member Benefit Agreement, Member Benefit Agreement

While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital and we will explain the reason(s) behind our decision.who is

Appears in 2 contracts

Samples: Member Benefit Agreement, Member Benefit Agreement

While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital and we will explain the reason(s) behind our decisiondecision .

Appears in 1 contract

Samples: Member Benefit Agreement

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While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days days, and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital who is acting as the Member’s representative during their inpatient stay, and we will explain the reason(s) behind our decision.

Appears in 1 contract

Samples: Member Benefit Agreement

While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital who is acting as the Member’s representative during their inpatient stay and we will explain the reason(s) behind our decision.

Appears in 1 contract

Samples: Member Benefit Agreement

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