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Emergency Services

Provider Administrative Policy

Commercial Managed Care
Policy Date
April 2007
Reviewed/May 2008
Provider Type(s)
All Providers  


Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an effcient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.


Emergency Services

Prior authorization for treatment of emergency medical conditions is not required. Blue Cross of Idaho will cover emergency services whether the member is in or out of the service area. Blue Cross of Idaho offers a worldwide emergency benefit. All medical care received during the inpatient stay will be considered in-network, as part of the member’s emergency care benefit. (Refer to PAP241 for additional information on prior authorization/referral requirements).

Emergency services are services that are provided in a hospital or other emergency facility after the sudden onset of a medical condition that manifests itself by symptoms of sufficient severity. These symptoms include, but are not limited to; severe pain and the absence of immediate medical attention could reasonably be considered by a prudent layperson to be an emergent medical condition. The following are examples of possible need for emergency services:

  1. a condition placing the patient’s health in serious jeopardy;
  2. a serious impairment to bodily functions; or
  3. a serious dysfunction of any bodily organ or part.

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