Common use of Covered Inpatient Hospital Services Clause in Contracts

Covered Inpatient Hospital Services. A Member will receive benefits for the Covered Services listed below when admitted to a hospital. Coverage of inpatient hospital services is subject to certification by utilization management for Medical Necessity. Benefits are provided for: A. Room and Board Room and board in a semiprivate room (or in a private room when Medically Necessary as determined by CareFirst). B. Physician, Medical, and Surgical Services Medically Necessary inpatient physician, medical, and surgical services provided by or under the direction of the attending physician and ordinarily furnished to a patient while hospitalized. C. Services and Supplies Related inpatient services and supplies that are not Experimental/Investigational, as determined by CareFirst, and ordinarily furnished by the hospital to its patients, including: SAMPLE 1. The use of: a) Operating rooms; b) Treatment rooms; and c) Special equipment in the hospital. 2. Drugs, medications, solutions, biological preparations, anesthesia, and services associated with the administration of the same. 3. Medical and surgical supplies. 4. Blood, blood plasma, and blood products, and related donor processing fees that are not replaced by or on behalf of the Member. Administrations of infusions and transfusions are covered. 5. Surgically implanted Prosthetic Devices that replace an internal part of the body. This includes hip joints, skull plates, cochlear implants, and pacemakers. Available benefits under this provision do not include items such as dental implants, fixed or removable dental Prosthetics, artificial limbs, or other external Prosthetics, which may be provided under other provisions of this Description of Covered Services. 6. Medical social services.