As part of Innovation Health’s commitment to patient safety and quality, Innovation Health will not pay facility charges for “Never Events” and some charges for "Serious Reportable Events" as described below.
The facility is required to notify Innovation Health of any Never Events, and Serious Reportable Events that occur in the provision of care to Innovation Health Members. The facility will waive all charges related to the Never Event or charges directly and solely related to the Serious Reportable Event. The facility will submit the bill identifying the event to Innovation Health but cannot charge the member or Innovation Health for the directly and solely related care and services provided. If Innovation Health learns of a potential Never Event or Serious Reportable Event – Reimbursement Review by a source other than the hospital, Innovation Health will notify the hospital and this policy will apply. Furthermore, if the claim has been reimbursed, we maintain the right to seek recovery of the overpaid charges as applicable.
****For purposes of this policy, Innovation Health has adopted the definitions and their revisions of Serious Reportable Events established by the National Quality Forum.
The National Quality Forum defines a "Never Event" as "errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility." For purposes of this policy, Innovation Health has determined the following events to be "Never Events:"
In addition to the three Never Event situations, the National Quality Forum (NQF) has released a list of twenty-
five Serious Reportable Events. These are considered by NQF to be potentially avoidable conditions “which could
reasonably have been prevented through application of evidence based guidelines”. These conditions are not present
when patients are admitted to a facility, but occur during the course of the stay.
For the following Serious Reportable Events, the facility should submit claims to Innovation Health, but the facility should waive all costs directly and solely related to these events. Innovation Health will not pay for charges directly and solely related to these Serious Reportable Events, including an extended length of stay due to the event.
The facility should submit claims for the following NQF Serious Reportable Events. Under the scope of this policy, reimbursement is not affected for the following conditions:
Health benefits and health insurance plans are offered and/or underwritten by Innovation Health Insurance Company and Innovation Health Plan, Inc. Innovation Health Insurance Company and Innovation Health Plan, Inc. are affiliates of Inova and of Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Innovation Health.
Teladoc and Teladoc physicians are independent contractors and are neither agents nor employees of Aetna or Innovation Health. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.
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