Welfare Summary Plan Description

6.6 CONCURRENT (CONTINUED STAY) REVIEW

When you are receiving medical services in a Hospital or specialized facility, the Utilization Management Organization may contact you to assure that continuation of medical services is Medically Necessary.

Concurrent Review may include such services as:

  • coordinating Home Health Care or the provision of Durable Medical Equipment;
  • determining the Medical Necessity of continued medical services; and/or
  • advising you of the various options covered under this Plan for your medical care.

The Plan pays no benefits for charges related to days of confinement in a Hospital or specialized facility that have not been determined to be Medically Necessary.