Section 550.1418 Emergency Health Services; Medical Coverage Required; “Stabilization” Defined.

MI Comp L § 550.1418 (2019) (N/A)

Copy with citation

Copy as parenthetical citation

Sec. 418.

(1) A health care corporation certificate that provides coverage for emergency health services shall provide coverage for medically necessary services provided to a member for the sudden onset of a medical condition that manifests itself by signs and symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to the individual's health or to a pregnancy in the case of a pregnant woman, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. A health care corporation shall not require a physician to transfer a patient before the physician determines that the patient has reached the point of stabilization. A health care corporation shall not deny payment for emergency health services up to the point of stabilization provided to a member under this subsection because of either of the following:

(a) The final diagnosis.

(b) Prior authorization was not given by the health care corporation before emergency health services were provided.

(2) As used in this section, “stabilization” means the point at which no material deterioration of a condition is likely, within reasonable medical probability, to result from or occur during transfer of the patient.

History: Add. 1998, Act 124, Imd. Eff. June 10, 1998 ;-- Am. 2004, Act 8, Imd. Eff. Feb. 20, 2004 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350

Previous Section

Section 550.1417 Hospice Care; Contracts With Health Care Corporation; Description of Benefit.

Next Section

Section 550.1419 Certificate Offering Dependent Coverage to Child; Denial of Enrollment on Certain Grounds Prohibited.