Pennsylvania Statutes Title 40 P.S. Insurance § 991.2116. Emergency services

If an enrollee seeks emergency services and the emergency health care provider determines that emergency services are necessary, the emergency health care provider shall initiate necessary intervention to evaluate and, if necessary, stabilize the condition of the enrollee without seeking or receiving authorization from the managed care plan.  The managed care plan shall pay all reasonably necessary costs associated with the emergency services provided during the period of the emergency.  When processing a reimbursement claim for emergency services, a managed care plan shall consider both the presenting symptoms and the services provided.  The emergency health care provider shall notify the enrollee's managed care plan of the provision of emergency services and the condition of the enrollee.  If an enrollee's condition has stabilized and the enrollee can be transported without suffering detrimental consequences or aggravating the enrollee's condition, the enrollee may be relocated to another facility to receive continued care and treatment as necessary.


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