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Section 127456 Of Article 2. Emergency Physician Fair Pricing Policies From California Health And Safety Code >> Division 107. >> Part 2. >> Chapter 2.5. >> Article 2.
127456
. (a) The period described in Section 127455 shall be
extended if the patient has a pending appeal for coverage of the
services, until a final determination of that appeal is made, if the
patient makes a reasonable effort to communicate with the emergency
physician about the progress of any pending appeals.
(b) For purposes of this section, "pending appeal" includes any of the following:
(1) A grievance against a contracting health care service plan, as described in Chapter 2.2 (commencing with Section 1340) of Division 2, or against an insurer, as described in Chapter 1 (commencing with Section 10110) of Part 2 of Division 2 of the Insurance Code.
(2) An independent medical review, as described in Section 10145.3 or 10169 of the Insurance Code.
(3) A fair hearing for a review of a Medi-Cal claim pursuant to Section 10950 of the Welfare and Institutions Code.
(4) An appeal regarding Medicare coverage consistent with federal law and regulations.
(b) For purposes of this section, "pending appeal" includes any of the following:
(1) A grievance against a contracting health care service plan, as described in Chapter 2.2 (commencing with Section 1340) of Division 2, or against an insurer, as described in Chapter 1 (commencing with Section 10110) of Part 2 of Division 2 of the Insurance Code.
(2) An independent medical review, as described in Section 10145.3 or 10169 of the Insurance Code.
(3) A fair hearing for a review of a Medi-Cal claim pursuant to Section 10950 of the Welfare and Institutions Code.
(4) An appeal regarding Medicare coverage consistent with federal law and regulations.
