$4 if performed in an outpatient hospital Radiation therapy and Chemotherapy services There is no limit on private duty nursing for children up to their 21st birthday. Private duty nursing is limited to 16 hours a day for adults. Private Duty Nurse who provides one-on-one care to patients $10 per covered day or 50% of the averaged allowable daily rate, whichever is less.Ĭleft palate surgery, bariatric surgery and dental anesthesia may be covered.īreast reconstructive surgery may be covered for members with a history of breast disease diagnosis and surgical procedure within the prior 5 years. Inpatient Medical or Surgical Care that requires you to be admitted to the hospital Outpatient hospital services that do not require you to be admitted to the hospital Outpatient surgery that takes place at an Ambulatory Surgery Center Outpatient surgery at an Ambulatory Surgery Center $2 per visit if not part of an emergency room. Learn more about Non-Emergent Medical Transportation. Prior authorization is only required when it is non-emergent, like being transferred to a new hospital. Prior authorization is not required for emergency ambulance services. Learn more about Hospital Emergency Services.Īmbulance services and other non-emergent transportation No co-pays if determined an emergency $8 per visit if not emergency. Hospitalization, Emergency Services, Transportation and Other Services Benefit Members must be part of the telemedicine appointment.Īdult vision care benefit includes medically necessary eye exams, glasses and contact lenses only after surgery.ĭoes not include orthoptic or eye training therapy. No co-pay for telemedicine but co-pays may apply for other services provided. Telemedicine is a way of helping to get services to members who live far away from Prior authorization is approved for 6-12 months at a time, but a client can get an unlimited number of prior authorizations.
Members can get longer home health if you develop a new issue or a current problem gets worse.įor member’s long term home health needs, you must get prior authorization or approval. Home health allows patients to get some care they need at homeįor a member’s acute care home health needs lasting 60 days or less, members can get all necessary services without prior authorization or approval. Specialist visit examples include being seen by a urologist, cardiologist or endocrinologist and others
Talk to your primary care provider or regional organization. Investigative and experimental treatments are not covered One visit to a provider for the same issue per day. Primary Care Medical Provider Visit for Illness or injuryĬhildren under age of 19 and pregnant women do not have co-pays. Before your in-person or telehealth appointment: Get Ready For Your Visit Benefit
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