Friday, January 10, 2020

Emergency Services Coverage & Billing

Indiana Health Coverage Programs (IHCP) recently provided a clarification of Package E - Emergency Services Only coverage and billing for certain non-U.S. citizens. Emergency Services are defined as services required for a medical condition manifesting itself by acute symptoms serious enough that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to the individual’s health, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. 

Some examples include:

  • Labor and delivery, including a C-section
  • Suspected heart attack or stroke
  • Broken limbs
  • Difficulty breathing

Package E covers all the following aspects of emergency care:

  • Hospital inpatient costs
  • Inpatient and outpatient physician costs
  • Pharmacy/prescription drug costs
  • Labs
  • Imaging test such as x-rays
  • Anesthesia

If a Package E member has an emergency and seeks services, they should not be billed for any part of that care. Covered services are reimbursed under the fee-for-service delivery system. 

Women who are Lawful Permanent Residents (LPRs) and become pregnant can also receive prenatal and postpartum services until 60 days after the pregnancy ends. Package E women who are not LPRs are not eligible for routine prenatal and postpartum services. 

Originally posted by Covering Kids & Families of Indiana

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