![]() ![]() ![]() Medicare didn't cover your hospital stay.Medicare generally won't pay for services (like return ambulance trips home) in either of these cases: Part B covers emergency and non-emergency ambulance and doctor services you get immediately before and during your covered foreign inpatient hospital stay.In the situations above, Medicare pays only for services covered underĬovers hospital care (care you get when you've been formally admitted with a doctor's order to the foreign hospital as an inpatient). You also pay the coinsurance, copayments, and deductibles you'd normally pay if got these same services or supplies inside the U.S. This includes any medically necessary doctor and ambulance services you get in a foreign country as a part of a covered inpatient hospital stay. In the situations described above, you pay the part of the charge you would normally pay for covered services. You pay 100% of the costs, in most cases. Medicare may cover medically necessary ambulance transportation to a foreign hospital only with admission for medically necessary covered inpatient hospital services. hospital that can treat your medical condition, regardless of whether an emergency exists. and the foreign hospital is closer to your home than the nearest U.S. You're traveling through Canada without unreasonable delay by the most direct route between Alaska and another U.S state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S.hospital that can treat your medical condition. when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. Medicare may pay for inpatient hospital, doctor, and ambulance services you get in a foreign country in these rare cases: However, Medicare won't pay for health care services you get when a ship is more than 6 hours away from a U.S. May pay for services that you get on board a ship within the territorial waters adjoining the land areas of the U.S. IF YOU HAVE ANY QUESTIONS REGARDING THE AUTHORIZATIONS PROCESS, PLEASE FEEL FREE TO CONTACT THE KEY MEDICAL GROUP AT (559) 734-1321, 8 AM TO 5 PM MONDAY THROUGH FRIDAY.Medicare usually doesn’t cover health care while you’re traveling outside the U.S. There are some exceptions, including some cases where If you need help with a grievance which had not been satisfactorily resolved, or has remained unresolved for more than 30 days, you may call the DMHC for assistance. If you have a grievance against the health plan, you should first telephone the plan and use the grievance process before contacting DMHC. The department has a toll free number (80) to receive complaints regarding health care plans. The DMHC is responsible for regulating health care plans. ![]() In addition to the process described above, you may also contact the California Department of Managed Health Care (DMHC). For more information please refer to the health plan's Appeals & Grievance process available through their website. Once an appeal is in process, your health plan will notify Key Medical Group and will request a copy of your denial letter and any notes we've received from your physician.Įvery health plan follows different guidelines and procedures. An appeal may be filed either by telephone, writing and with some health plans, online. If it were determined by the health plan that an appeal meets this criteria, an expedited review would apply to the case. An expedited appeal would be requested if it is determined that a delay in the decision making process might pose an imminent and serious threat to the patient's health. A provider or patient may file an appeal. All appeals for denied services are handled directly through your health plan (Blue Shield, Anthem Blue Cross, etc.). ![]()
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