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Agenda - 06-28-1989
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Agenda - 06-28-1989
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3/10/2017 4:29:57 PM
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BOCC
Date
6/28/1989
Meeting Type
Regular Meeting
Document Type
Agenda
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29 <br /> SECTION V <br /> LIIrICIITISICOVERAE <br /> 1. Referral Health Services <br /> Referral by a Participating Physician to a non-participating <br /> Physician or Provider: In the unlikely event that Covered Health <br /> Services cannot be provided by a Participating Physician and/or <br /> a Participating Provider, the Member shall be referred to <br /> another physician or provider that can provide the Medically • <br /> Necessary Health Services. Such Health Services must be <br /> recommended in writing by the Participating Physician, and must <br /> have prior approval in writing, from the Plan's Medical Services <br /> Department to be Covered by the Plan, and will be subject to the <br /> Limitations and Exclusions of this Contract. The Plan will not <br /> pay for any referral Health Services not recommended by the <br /> Participating Physician and/or not approved by prior written <br /> notice of the Medical Services Department except for necessary <br /> • Emergency Care as described in Section V, Article 2. <br /> 1 2. Emer9eflqy Services <br /> A. Within the Plan's Service Area <br /> . . <br /> Eligible Expenses for emergency care are Covered within the <br /> Plan's service area. Members pay a copayment for Emergency <br /> Health Services. Members must contact their Personal <br /> Physician before seeking Emergency Care, unless the delay <br /> could reasonably risk the Member's life or result in <br /> permanent Disability. Whenever possible consistent with <br /> reasonable and prudent standards of medical care, <br /> continuing or follow-up medical treatment, related to the <br /> 24 • <br />
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