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California Law (Last Updated: March 4, 2014) |
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Health and Safety Code - HSC |
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Division 107. STATEWIDE HEALTH PLANNING AND DEVELOPMENT |
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Part 2. HEALTH POLICY AND PLANNING |
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Chapter 2.5. Fair Pricing Policies |
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ARTICLE 2. Emergency Physician Fair Pricing Policies |
Section 127456.
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(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.