Office Visits. We cover medically necessary office visits provided they are reasonable in number and in the scope of the services rendered for the following: • office visits to primary care physicians; • office visits to specialists; • routine examinations; • consultations; • medication visits for outpatient mental illness; • office visits to oral and maxillofacial surgeons (OMS) for medical conditions; or • retail based clinics.
Office Visits. Benefits are available for office visits for the diagnosis and treatment of a medical condition, including care and consultation provided by primary care providers and Specialists.
Office Visits. Medical Care visits for the exam, diagnosis and treatment of an illness or injury by a Member’s Primary Care Physician. This also includes physical exams and routine child care, including well-baby visits. For the purpose of this benefit, Office Visits include Medical Care visits to a Member’s Primary Care Physician's office, during and after regular office hours, Emergency visits and visits to a Member's residence, if within Keystone's Limited Network Area.
Office Visits a. See all exclusions.*
Office Visits. The Plan provides Benefits for office visits to Providers. Office visits include visits to retail health clinics and walk-in centers and are covered as Office Visits. Services at a retail health clinic are limited to basic health care services to Members on a walk-in basis. These clinics are normally found in major pharmacies and retail stores. Services are typically provided by nurse practitioners or physician’s assistants and without an appointment. Services are limited to routine care and treatment of common illnesses for adults and children. Services rendered during an office visit, such as medical exams, management of therapy, injections, surgery and anesthesia, may be subject to additional charges beyond office visit Out-of-Pocket Costs. Online Visits When available in the Member’s area, the Plan provides coverage that will include online visit services. Covered Services include a medical consultation. The Plan does not cover communications used for: reporting normal lab or other test results, office appointment requests, billing, insurance coverage or payment questions, requests for referrals to Providers outside the online care panel, benefit precertification, physician to physician consultation. Please refer to the “Telehealth” provisions for additional or different services available.
Office Visits. Physicians and other Providers who You see in an office setting will provide You with both primary care and specialty care services. These Covered Services may include annual examinations, routine immunizations, and treatment of non-emergency/acute illnesses and injuries. For preventive, routine or specialty care, call or make an appointment with Your Physician or other Provider. Your Provider will arrange for Preauthorization as needed. If You need a same day appointment or have an Urgent Illness, call Your Physician’s office to make an appointment. If Your Provider is unable to see You, You may be offered an appointment with another Physician, Certified Nurse Practitioner or Physician Assistant in his/her group. After hours, Your Physician may offer an answering service. When You arrive for Your appointment show Your Plan ID card to the receptionist. You may be required to make a Copay before receiving services. If You are unable to keep an appointment, cancel as soon as possible, as missed appointment charges may apply and those charges are not covered under the Plan. Telemedicine and telehealth services are Covered Services under this Contract at the same level and copayment amounts as other office visits. Ambulance Service If you need an Ambulance, call 911 or a local Ambulance service. This service is covered if it is Medically Necessary because of an emergency. The Plan’s Medical Director determines this by reviewing Ambulance and medical records. Non-Emergency Ambulance transport requires Preauthorization from the Plan. If Ambulance services are not Medically Necessary and are not authorized by the Plan, You are responsible for payment.
Office Visits. Sickness or injury – Office visits related to diagnosis, care or treatment of a medical, mental health or substance use related condition, sickness or injury. • Telemedicine. • Allergy visits. • Port wine stain elimination or maximum feasible treatment to lighten or remove the discoloration. • Nutritional counseling provided: ✓ As outpatient self- management training and education for the diagnosis and treatment of diabetes by a certified, registered, or licensed health care professional working in a program consistent with the national standards of diabetes self-management education as established by the American Diabetes Association; or ✓ Through a provider’s office, clinic system or hospital setting to a member who has been diagnosed by a physician, physician assistant or advanced practice registered nurse with a chronic medical condition; or ✓ As counseling that is treated as a preventive health care service. Note: Some services that may be provided during an office visit may be subject to the deductible such as, but not limited to, laboratory, pathology, radiology, and surgical procedures. Primary Care Practitioner 100% of eligible charges after a $25 member copayment per visit for visits with a primary care practitioner, except for visits for a mental health or substance use disorder. Deductible does not apply.
Office Visits. Sickness or injury – Primary care practitioner and other provider office visits related to diagnosis, care or treatment of a medical, mental health or substance use related condition. • Telemedicine. • Allergy visits. • Port wine stain elimination or maximum feasible treatment to lighten or remove the discoloration. • Nutritional counseling provided: ✓ As outpatient self- management training and education for the diagnosis and treatment of diabetes by a certified, registered, or licensed health care professional working in a program consistent with the national standards of diabetes self-management education as established by the American Diabetes Association; or ✓ Through a provider’s office, clinic system or hospital setting to a member who has been diagnosed by a physician, physician assistant or advanced practice registered nurse with a chronic medical condition; or ✓ As counseling that is treated as a preventive health care service. Note: Some services that may be provided during an office visit may be subject to the deductible such as, but not limited to, laboratory, pathology, radiology, and surgical procedures. Primary Care Practitioner 100% of eligible charges after a $45 member copayment per visit for visits with a primary care practitioner, except for visits for a mental health or substance use disorder. Deductible does not apply.
Office Visits. For prescription drug coverage, see Section 3.27 - Prescription Drugs and Diabetic Equipment/Supplies. See the Summary of Pharmacy Benefits for benefit limits and the amount that you pay. Electroconvulsive Therapy
Office Visits. The Plan provides Benefits for office visits to Providers. Services rendered during an office visit, such as medical exams, management of therapy, injections, surgery and anesthesia, may be subject to additional charges beyond office visit Out-of-Pocket Costs. Online Visits When available in the Member’s area, the Plan provides coverage that will include online visit services. Covered Services include a medical consultation. The Plan does not cover communications used for: reporting normal lab or other test results, office appointment requests, billing, insurance coverage or payment questions, requests for referrals to Providers outside the online care panel, benefit precertification, physician to physician consultation. Please refer to the “Telemedicine” provisions for additional or different services available and applicable requirements.
