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.