6.5.5
CONCURRENT (CONTINUED STAY) REVIEW
When you are receiving medical services in a Hospital
or specialized facility, the Utilization Management Organization
may contact you to assure that continuation of medical
services is Medically Necessary .
Concurrent Review may include such services as:
- coordinating Home Health
Care or the provision of Durable Medical Equipment;
- determining the Medical
Necessity of continued medical services; and/or
- advising you of the various
options covered under this Plan for your medical care.
The Plan pays no benefits for charges related to days
of confinement in a Hospital or specialized facility that
have not been determined to be Medically Necessary.
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