Emergency Services

Emergency services are services that :

• Are medically necessary and
• Result from a medical condition or behavioral health condition, including labor and delivery, manifesting itself by acute symptoms of sufficient severity, including severe pain, and
• Which, in the absence of immediate medical attention, is reasonably likely to result in at least one of the following:
  • Placing the individual's health in serious jeopardy,
  • Serious impairment to bodily functions,
  • Serious dysfunction of any bodily organ or part, or
  • Serious physical harm to another person.

Emergency services include outpatient dialysis services for a person with End Stage Renal Disease (ESRD) where a treating physician has certified that in his opinion the absence of receiving dialysis at least three times per week would reasonably be expected to result in:

• Placing the patient's health in serious jeopardy,
• Serious impairment of bodily function, or
• Serious dysfunction of a bodily organ or part.