Health Net follows the Medicare definition of an emergency medical condition and emergency services as follows:
An emergency medical condition is a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in the following:
- Serious jeopardy to the health of the individual or, in the case of a pregnant woman, the health of the woman or her unborn child;
- Serious impairment to bodily functions; or
- Serious dysfunction of any bodily organ or part.
Emergency services means covered inpatient and outpatient services that are:
- Furnished by a provider qualified to furnish emergency services; and
- Needed to evaluate or treat an emergency medical condition.