Emergency Medical Condition
Emergency Medical Condition
Being able to establish immediately - "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
(a) Serious jeopardy to patient health.
(b) Serious impairment to bodily functions.
(c) Serious dysfunction of any bodily organ or part.
or
Upon referral by a provider described in subparagraph 1., followup services and care consistent with the underlying medical diagnosis rendered pursuant to subparagraph 1. which may be provided, supervised, ordered, or prescribed only by a physician licensed under chapter 458 or chapter 459, a chiropractic physician licensed under chapter 460, a dentist licensed under chapter 466, or, to the extent permitted by applicable law and under the supervision of such physician, osteopathic physician, chiropractic physician, or dentist, by a physician assistant licensed under chapter 458 or chapter 459 or an advanced registered nurse practitioner licensed under chapter 464. Followup services and care may also be provided by any of the following persons or entities:
What form should the EMC take?
Ideally, something more than just a checked box, to avert the insurance company’s suspicion. I believe an EMC should be incorporated into: either an initial office note where a comprehensive examination is done, complete with the patient consultation and MRIs; or, in a subsequent follow-up visit, if MRIs were not previously done. While not required, I highly recommend using the language of the statutory definition to alleviate any ambiguity or lingering questions by the adjuster. In other words, be sure to word your statement about the EMC with similar language to that found in the statute.
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