6.6 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.