Examples of Emergency room services in a sentence
You may also request an external appeal by an outside agency if you are dissatisfied with our appeal determination related to any of the following special circumstances as described in more detail in Section 6: • Emergency room services; • Air ambulance services; • Non-emergency covered healthcare services rendered by a non-network provider at certain network facilities.
Emergency room services should be reported for any patient (new or established) who presents for treatment in the emergency department.
The Contractor shall instruct its provider network of the Emergency room services copayment policy and procedure, such as the hospital's notification responsibilities (outlined above) and the circumstances under which the hospital must waive or return the copayment.
These services, however, are subject to a co-pay:• Ambulance services for a non-emergency;• Chiropractic;• Emergency room services for a non-emergency;• Podiatric;• Eye and vision services provided by an optometrist;• Physical and Occupational Therapy;• Speech Language Pathology;• Physician and Non-physician practitioner services;• Federally Qualified Health Centers (FQHC); and• Rural Health Clinics (RHC).
Emergency room services for all plans will be $100.00 per visit in addition to any applicable calendar year deductible.
Emergency room services provided by a dentist – facility and anesthesia charges are covered under Inpatient Hospitalization and Surgical Benefits.Dental procedures that require emergency care can be reviewed retrospectively to determine coverage under Dental Benefits.Inpatient Hospital Services:All dental services that are to be rendered in a hospital setting require precertification.
Emergency room services provided by a dentist – facility and anesthesia charges are covered under Inpatient Hospitalization and Surgical Benefits.Dental procedures that require emergency care can be reviewed retrospectively todetermine coverage under Dental Benefits.Inpatient Hospital Services:All dental services that are to be rendered in a hospital setting require precertification.
Examples of services that may not be Covered include, but are not limited to:• Emergency room services shortly after you left a facility against medical advice.• A Hospital stay to treat complications caused by leaving a facility against medical advice.• A Hospital stay to treat complications caused by purposeful non-compliance with a treatment plan.
Covered Services• Urgent care• Surgery• Diagnostic tests and X-rays• Dialysis• Emergency room services for a medical emergency• Post-stabilization care Service Authorization RequirementsA service authorization may be required for specific outpatient services (e.g., specific surgicalprocedures, out-of-network services).
May apply in the following circumstances:▪ Emergency room services: An Access Fee per visit will apply, unless that visit results in an impatient admission into that Hospital immediately following the Emergency room visit.▪ Pharmacy requires fulfillment of an Additional Deductible for Brand Name Prescription Drugs.