We use cookies on our site to analyze traffic, enhance your experience, and provide you with tailored content.

For more information visit our privacy policy.

AMBULATORY SURGICAL CENTER Sample Clauses

AMBULATORY SURGICAL CENTER. (FREESTANDING) means a state licensed facility, which is equipped to provide surgery services on an outpatient basis.
AMBULATORY SURGICAL CENTER. An Allied Health Facility Provider that is established with an organized medical staff of Physicians. This type of center has permanent facilities that are equipped and operated mainly to perform surgical procedures. A center has continuous Physician and registered professional nursing services available whenever patients are in the facility, does not provide services or other accommodations for patients to stay overnight, and offers the following services whenever patients are in the center: Appeal – A request from a Member or a Member’s authorized representative to change a decision We made about Benefits. Bed, Board and General Nursing Service – Room accommodations, meals, and all general services and activities that Hospital employees provide to care for patients. This service includes all nursing care and nursing instructional services provided as a part of the Hospital’s bed-and-board charge.
AMBULATORY SURGICAL CENTERServices rendered at an Ambulatory Surgical Center include:
AMBULATORY SURGICAL CENTERThe services set forth in Section 3.12.1 of this Certificate are Covered Services when provided in an Ambulatory Surgical Center setting by physician Providers (or other physicians in response to an emergency) or under the orders of a physician.
AMBULATORY SURGICAL CENTERA Facility currently licensed by the appropriate state regulatory agency for the provision of surgical and related medical services on an outpatient basis. Authorized Service(s): A Covered Service rendered by any Provider other than a Network Provider, which has been authorized in advance (except for Emergency Care which may be authorized after the service is rendered) by Us to be paid at the Network level. The Member may be responsible for any applicable Network Coinsurance, Copayment or Deductible. For more information, see the Claims Payment section. Balance Billing: When a Non-Network Provider bills You for the difference between the Non-Network Provider’s charge and the Allowed Amount. A Network Provider may not Balance Bill You for Covered Services. Benefit Period or Plan Year: The 12 months that We will pay benefits for Covered Services. If Your coverage ends before this length of time, then the Benefit Period also ends. The Benefit Period or Plan Year begins on Your Effective Date, which means it may not correspond with the calendar year. Benefit Period Maximum: The maximum that We will pay for specific Covered Services during a Benefit Period. Brand Name Drug: The first version of a particular medication to be developed or a medication that is sold under a pharmaceutical manufacturer’s own registered trade name or trademark. The original manufacturer is granted a patent, which allows it to be the only company to make and sell the new drug for a certain number of years. Child, Children: The Subscriber’s Children, including any natural, adopted or step- children, unmarried disabled Children, newborn Children, or any other Children as described in the Who is Covered section of this Policy. Coinsurance: A specific percentage of the Maximum Allowable Amount for Covered Services, that is indicated in the Schedule of Benefits, which You must pay. Coinsurance normally applies after the Deductible that You are required to pay. See the Schedule of Benefits for any exceptions. Copayment: A specific dollar amount of the Maximum Allowable Amount for Covered Services, that is indicated in the Schedule of Benefits, which You must pay. The Copayment does not apply to any Deductible that You are required to pay. Cost-Sharing: Amounts You must pay for Covered Services, expressed as Copayments, Deductibles and/or Coinsurance. Cost-Sharing Reductions: Discounts that lower cost-sharing for certain services covered by individual HMO or health insurance purchased throug...
AMBULATORY SURGICAL CENTERA Facility currently licensed by the appropriate state regulatory agency for the provision of surgical and related medical services on an outpatientbasis. Appeal: a Grievance concerning Adverse Determinations, including urgent care, concurrent, pre-service or post-service claims. Authorized Service(s): A Covered Service rendered by any Provider other than a Network Provider, which has been authorized in advance (except for Emergency Care which may be authorized after the service is rendered) by Us to be paid at the Network level, subject to any applicable Network Coinsurance, Copayment or Deductible. For more information, see the Claims Payment section. Balance Billing: When a Non-Network Provider bills You for the difference between the Non-Network Provider’s charge and the Allowed Amount. A Network Provider may not Balance Bill You for Covered Services. Behavioral Health Services: Services or supplies to treat a mental or emotional condition or substance use disorder. Benefit Period: The length of time that We will pay benefits for Covered Services. The Benefit Period is listed in the Schedule of Benefits. If Your coverage ends before this length of time, then the Benefit Period also ends.

Related to AMBULATORY SURGICAL CENTER

  • Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. This plan covers respiratory therapy services. When respiratory services are provided in your home, as part of a home care program, durable medical equipment, supplies, and oxygen are covered as a durable medical equipment service.

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.

  • Mastectomy Services Inpatient

  • Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services. This plan covers dental care for members until the last day of the month in which they turn nineteen (19). This plan covers services only if they meet all of the following requirements: • listed as a covered dental care service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered dental care service under this plan. • dentally necessary, consistent with our dental policies and related guidelines at the time the services are provided. • not listed in Exclusions section. • received while a member is enrolled in the plan. • consistent with applicable state or federal law. • services are provided by a network provider.

  • Ambulance Services Ground Ambulance Air and Water Ambulance