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Current through October 23, 2012
(a) All health insurers, hospitals or medical services corporations, and health maintenance organizations shall reimburse for emergency services that are due to a medical emergency.
(b) A hospital emergency department or emergency medical service transporter shall provide a health insurer, hospital or medical services corporation, or health maintenance organization with any claim for reimbursement of services, and information on the presenting symptoms of the insured as well as the services provided.
(c) A health insurer, hospital or medical services corporation, or health maintenance organization shall consider both the presenting symptoms and the services provided in processing a claim for reimbursement of emergency services.
(d) A health insurer, hospital or medical services corporation, or health maintenance organization may not deny reimbursement, except for co-payments, deductibles, and co-insurance, for the provision of emergency services that are due to a medical emergency solely because the member failed to obtain pre-authorization for emergency services from the health insurer, hospital or medical services corporation, or health maintenance organization.
(Sept. 11, 1998, D.C. Law 12-145, § 3, 45 DCR 3785.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 35-4802.
Legislative History of Laws
For legislative history of D.C. Law 12-145, see Historical and Statutory Notes following § 31-2801.
