Necessary care definition
Examples of Necessary care in a sentence
PIPs must not contain provisions that provide incentives, monetary or otherwise, for the withholding of Medically Necessary care.
Admission must be appropriate for your Medically Necessary care and rehabilitation.
Specific directions or instructions from a Member’s PCP, in conformance with HMO’s policies and procedures, that direct a Member to a Participating Provider for Medically Necessary care.
The ACO shall ensure that post-discharge home visits are not used to prevent or deter a Beneficiary from seeking or receiving other Medically Necessary care.
In the event that Members are unable to obtain a PCP Referral for Medically Necessary care in advance of receipt of the Urgent Care services, they should notify their PCP by the next business day.
The ACO shall ensure that care management home visits are not used to prevent or deter a Beneficiary from seeking or receiving other Medically Necessary care.
Such services are covered when a Member is homebound for medical reasons, physically not able to obtain Medically Necessary care on an outpatient basis, under the care of a Physician and such care is given in place of Inpatient Hospital or Skilled Nursing Facility care.
Medically Necessary care provided by any Provider other than a Member’s Primary Care Physician will be covered, subject to the Section CS - Description of Covered Services, Section EX - Exclusions, Section SC - Schedule of Cost Sharing sections, and the Medical Care Preauthorization Schedule only until they can, without medically harmful consequences, be transferred to the care of their Primary Care Physician or a Referred Specialist designated by their Primary Care Physician.
Such services are covered when: such care is given in place of Inpatient Hospital or Skilled Nursing Facility care and/or; the Insured is not physically able to obtain Medically Necessary care on an outpatient basis; and/or the Insured is under the care of a Physician; and/or the Insured is homebound for medical reasons.
Enrollees with more serious problems not deemed Emergency Medical Conditions shall be triaged and, if necessary or appropriate, immediately referred for urgent Medically Necessary care or provided with an appointment within one (1) Business Day after the request.