Urgent Care Claim
An Urgent Care Claim is any claim for medical care
or treatment with respect to which the application
of the time periods for making Pre-Service Claim
determinations:
- Could seriously jeopardize the life or health of the claimant or the ability of the claimant to regain maximum function; or
- In the opinion of a physician with knowledge of the claimant’s medical condition, would subject the claimant to severe pain that cannot be adequately
managed without the care or treatment that is the subject of the claim.
Whether your claim is an Urgent Care Claim is determined
by the Claim Administrator applying the judgment
of a prudent layperson who possesses an average knowledge
of health and medicine. Alternatively, any claim that
a physician with knowledge of your medical condition
determines is an Urgent Care Claim within the meaning
described above will be treated as an Urgent Care Claim.
