Outpatient Hospital Services: Coverage And Limitations

01. Services Are Provided On-Site. (7-1-26) 02. Co-Payments. (7-1-26) a. When an emergency room physician determines that an emergency condition does not exist, the hospital can require the participant to pay a co-payment. (7-1-26) b. Services may be refused when determined an emergency condition does not exist, and the participant does not make the co-payment at the time of service. The hospital will provide notification to the participant per Section 1916A(e) of the SSA. (7-1-26)