Emergency care services means those services identified in 18 Del.C. §§3349(d) and 3565(d) performed at any time during the Duration of an Emergency Medical Condition, including any covered service providing for the transportation of a patient to a hospital emergency facility for an emergency medical condition including air and sea ambulances so long as medical necessity criteria are met.
Emergency care services. If a Member experiences a Medical Emergency while traveling outside Keystone’s Approved Service Area, medical treatment should be sought from the nearest appropriate Facility Provider. Whenever Members access covered healthcare services outside Keystone’s Approved Service Area and the claim is processed through the BlueCard Program, the amount Members pay for covered healthcare services, if not a flat dollar copayment, is calculated based on the lower of: The billed covered charges for their covered services; or The negotiated price that the Host Blue makes available to Keystone. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to the Member’s healthcare provider. Sometimes, it is an estimated price that takes into account special arrangements with the Member’s healthcare provider or provider group that may include types of settlements, incentive payments, and/or other credits or charges. Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of healthcare providers after taking into account the same types of transactions as with an estimated price. Estimated pricing and average pricing, going forward, also take into account adjustments to correct for over - or underestimation of modifications of past pricing for the types of transaction modifications noted above. However, such adjustments will not affect the price Keystone uses for Members’ claims because they will not be applied retroactively to claims already paid. Federal law or the laws in a small number of states may require the Host Blue to add a surcharge to this calculation. If federal law or any state laws mandate other liability calculation methods, including a surcharge, Keystone would then calculate Member liability for any covered healthcare services according to applicable law.
Emergency care services. If you experience a Medical Emergency while traveling outside our Service Area, go to the nearest Emergency or urgent care facility. Whenever You receive Covered Services and the claim is processed through the BlueCard Program, the amount you pay for such services, if not a flat dollar Copayment, is calculated based on the lower of: S the billed covered charges for the Covered Services, or S the negotiated price that the Host Blue makes available to us. Often, this “negotiated price” is a simple discount that reflects the actual price the Host Blue pays to your healthcare Provider. Sometimes, it is an estimated price that takes into account special arrangements with an individual Provider or a provider group that may include settlements, incentive payments, and/or other credit or charges. Occasionally, it may be an average price based on a discount that results in expected average savings for similar types of healthcare Providers after taking into account the same types of transactions as with an estimated price. Estimated pricing and average pricing also take into account adjustments to correct for over- or underestimation of past pricing of claims, as noted above. However, such adjustments will not affect the price we use for your claim because they will not be applied after a claim has already been paid. Federal or state laws or regulations may require a surcharge, tax or other fee that applies to insured accounts. If applicable, Blue Cross and Blue Shield of Texas will include any such surcharge, tax or other fee as part of the claim charge passed on to you. If federal law or any state laws mandate other liability calculation methods, including a surcharge, HMO would then calculate your liability for any Covered Services according to the applicable law in effect when care is received.
Examples of Emergency care services in a sentence
In the event that the member requires Emergency Care Services, benefits will be provided at the network services benefit levels.
In the event that the Member requires Emergency Care Services, all benefits for such Covered Services will be provided at the Network Services level of benefits.
When Emergency Care Services are received from a UPMC Provider that is an Out-of- Network Provider under this Agreement, benefits are provided as set forth in the EMERGENCY CARE SERVICES Subsection of SECTION DB - DESCRIPTION OF BENEFITS of this Agreement and also includes such other Services and supplies necessary to continue to treat the Member, including any resulting Inpatient admission, through the period of discharge.
Emergency Care Services This plan covers Emergency Care services, including supplies, outpatient charges for patient observation, Facility costs, and medical screening exams that are required for the stabilization of a patient experiencing a Medical Emergency.
All Accidental Injury (trauma), Urgent Care, Emergency Care Services, and Observation Services whether provide within or outside of the Plan’s Service Area are subject to the Limitations listed in the Limitations Section and the Exclusions listed in the Exclusions Section.
More Definitions of Emergency care services
Emergency care services means services for an emergency medical condition as defined in 31A-22-627(3).
Emergency care services means the immediate care or treatment necessary to prevent death, severe or permanent disability or to alleviate severe pain, including medically necessary crisis intervention for inmates suffering from situational crisis or acute episodes of mental illness, in accordance with CCR, Title 15.
Emergency care services means those services identified in 18 Del.C. §§3349(c) and 3565(c) including:
Emergency care services means serv- ices furnished to an individual for treatment of an ‘‘emergency medical condition’’ as that term is defined in § 422.2 of this chapter. Legal representative means one or more individuals who, as determined by applicable State law, has the legal authority to enter into the contract with the physician or practitioner on behalf of the beneficiary. Opt-out means the status of meeting the conditions specified in § 405.410. Opt-out period means the 2-year pe- riod beginning on the effective date of the affidavit as specified by § 405.410(c)(1) or § 405.410(c)(2), as appli- cable. Participating physician means a ‘‘phy- sician’’ as defined in this section who has signed an agreement to participate in Part B of Medicare. Physician means a doctor of medi- cine; doctor of osteopathy; doctor of dental surgery or of dental medicine; doctor of podiatric medicine; or doctor of optometry who is legally authorized to practice medicine, osteopathy, den- tal surgery, dental medicine, podiatric medicine, or optometry by the State in which he performs such function and who is acting within the scope of his li- cense when he performs such functions. Practitioner means a physician assist- ant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse midwife, clinical psychologist, or clinical social worker, who is currently legally au- thorized to practice in that capacity by each State in which he or she furnishes services to patients or clients.
Emergency care services means medical services provided for an emergency medical condition.
Emergency care services means those services identified in 18 Del.C. §§3349(c) and 3565(c) including: a provider who also provides health care services that aren't emergency care services.
Emergency care services has the meaning given to it in section 7 of the National Tariff Emergency Care Threshold each Emergency Care Services activity threshold in respect of the relevant Commissioner, as set out in Schedule 3D (Emergency Care Rule: Agreed Blended Payment Arrangements) European Economic Area or EEA the European Economic Area which consists of the European Union and all the European Free Trade Association (EFTA) countries except Switzerland Evidence-Based Interventions Policy the national policy relating to the commissioning of interventions which are clinically inappropriate or which are appropriate only when performed in specific circumstances, published by NHS England at: xxxxx://xxx.xxxxxxx.xxx.xx/publication/evidence-based-interventions-guidance-for-clinical-commissioning-groups-ccgs/ GP Referred Service a Service which accepts elective Referrals from GPs, as set out in NHS e-Referral Service guidance Guidance on Personalised Care guidance published by NHS England aimed at ensuring that people have choice and control over the way their care is planned and delivered, available at xxxxx://xxx.xxxxxxx.xxx.xx/publication/universal-personalised-care-implementing-the-comprehensive-model/ Learning Disability Improvement Standards the standards for the provision of healthcare services for people with learning disabilities, published by NHS Improvement at: xxxxx://xxxxxxxxxxx.xxx.xx/resources/learning-disability-improvement-standards-nhs-trusts/ Xxxxxx Xxxx the tool used to assess the cardiovascular and metabolic health of Services Users with severe mental illness, published by NHS England and the Royal College of Psychiatrists at: xxxxx://xxx.xxxxxxx.xx.xx/docs/default-source/improving-care/ccqi/national-clinical-audits/ncap-library/ncap-e-version-nice-endorsed-xxxxxx-uk-adaptation.pdf?sfvrsn=39bab4_2 Local System Operating Plan the aggregated system-wide operational plan and supporting narrative for 2019/20, to be submitted to NHS England and NHS Improvement by each Sustainability and Transformation Partnership and Integrated Care System, as described in NHS Operational Planning and Contracting Guidance 2019/20, available at: xxxxx://xxx.xxxxxxx.xxx.xx/publication/preparing-for-2019-20-operational-planning-and-contracting/ National Ambulance Vehicle Specification the final national specification for emergency ambulance vehicles to be used in the provision of NHS-funded services, to be published by NHS Improvement (consultation draft available at xxxxx://xxxxxx.xxxxx...