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.