The Trust will modify its procedures in situations involving urgent care claims. Urgent care claims are claims for services where the application of the normal time frames for appeals could seriously jeopardize the life or health of the claimant or expose the claimant to severe pain. Urgent care claims may be filed, orally or in writing, by you or a health care provider with knowledge of your medical condition. Urgent care claims only involve services that have not been provided as a result of the Trust's denial.

The Trust Office will make an initial decision on an urgent care claim within 72 hours of receipt. If additional information is needed to process the claim, you or your health care provider will be notified and given 48 hours to provide additional information.

If you appeal an urgent care claim, a decision will be made within five (5) working days of the appeal. The Claims Appeal Panel may meet via teleconferencing to consider an urgent care claim. Given the shorter time frame there will be no right to a personal appearance.