Common use of Office Visits Clause in Contracts

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. 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.