Oral Physician Surgical Services Sample Clauses

Oral Physician Surgical Services. Although dental services are not Covered Services, except as otherwise provide in the Attachment A Benefit Schedule, the following Oral Physician Surgical Services are Covered Services:  Treatment for tumors and cysts requiring pathological examination of the jaws, cheeks, lips, tongue, roof and floor of the mouth.  Removal of teeth necessary in order to perform radiation therapy.  Treatment required to stabilize sound natural teeth, the jawbones, or surrounding tissues after an Injury (not to include injuries caused by chewing) when the treatment starts within the first ten (10) days after the Injury and ends within sixty (60) days from the date of Injury. Examples of Covered Services, in such instances, include:  Root canal therapy, post and build up.  Temporary crowns.  Temporary partial bridges.  Temporary and permanent fillings.  Pulpotomy.  Extraction of broken teeth.  Incision and drainage.  Tooth stabilization through splinting. No benefits are provided for removable dental prosthetics, dentures (partial or complete) or subsequent restoration of teeth, including permanent crowns.
Sample 1Sample 2Sample 3See All (6)
AutoNDA by SimpleDocs
Oral Physician Surgical Services. Although dental services are not Covered Services, except as otherwise provide in the Attachment A Benefit Schedule, the following Oral Surgical Services are Covered Services:  Treatment for tumors and cysts requiring pathological examination of the jaws, cheeks, lips, tongue, roof and floor of the mouth.  Removal of teeth which are necessary in order to perform radiation therapy.  Treatment required to stabilize sound natural teeth, the jawbones, or surrounding tissues after an Injury (not to include injuries caused by chewing) when the treatment starts within the first ten (10) days after the Injury and ends within sixty (60) days from the date of Injury. Examples of Covered Services, in such instances, include:
Sample 1Sample 2Sample 3See All (5)
Oral Physician Surgical Services. No benefits will be paid for reconstructive surgery performed, or any complications relating to the reconstructive surgery, more than three (3) years following a mastectomy that was covered under this Plan if the patient is no longer covered by HPN under this Plan. Although dental services are not Covered Services, the following Oral Physician Surgical Services are Covered Services:  Treatment for tumors and cysts requiring pathological examination of the jaws, cheeks, lips, tongue, roof and floor of the mouth.  Removal of teeth which is necessary in order to perform radiation therapy.  Treatment required to stabilize sound natural teeth, the jawbones, or surrounding tissues after an Injury (not to include injuries caused by chewing) when the treatment starts within the first ten (10) days after the Injury and ends within sixty (60) days. Examples of Covered Services include:  Root canal therapy, post and build up.  Temporary crowns.  Temporary partial bridges.  Temporary and permanent fillings.  Pulpotomy.  Extractions of broken teeth.  Incision and drainage.  Tooth stabilization through splinting. No benefits are provided for removable dental prosthetics, dentures (partial or complete) or subsequent restoration of teeth, including permanent crowns.
Sample 1
Oral Physician Surgical Services. Although dental services are not Covered Services, except as otherwise provided in the Attachment A Benefit Schedule, the following Oral Surgical Services are Covered Services: • For Insureds up to age 19, services include the Medically Necessary treatment of:  Oral cancer;
Sample 1

Related to Oral Physician Surgical Services

  • Physician Visits This plan covers the services of a physician or other provider in charge of your medical care while you are inpatient in a general or specialty hospital.

  • Surgical Services All necessary procedures for extractions and other surgical procedures normally performed by a dentist.

  • Clinical Management for Behavioral Health Services (CMBHS) System The CMBHS is the official record of documentation by System Agency. Grantee shall:

  • Paramedical Services Services of the following registered/certified practitioners up to the maximums shown on the "Summary of Benefits" pages:

  • Medical Services We do not Cover medical services or dental services that are medical in nature, including any Hospital charges or prescription drug charges.

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. Inpatient This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. Residential Treatment Facility This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. Intermediate Care Services This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Emergency Medical Services The City’s Fire Department and MedStar (or other entity engaged by the City after the Effective Date) will provide emergency medical services.

  • Behavioral Health Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services, are a covered benefit under the Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). This includes, but is not limited to:  Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits.  Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work.  Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request.  Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members.  Providing out-of-network coverage for mental health or substance use disorder benefits when made available for medical and surgical benefits. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to:  Provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health;  Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and  Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

  • 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.

  • Durable Medical Equipment (DME), Medical Supplies Prosthetic Devices, Enteral Formula or Food, and Hair Prosthesis (Wigs) • Items typically found in the home that do not need a prescription and are easily obtainable such as, but not limited to: o adhesive bandages; o elastic bandages; o gauze pads; and o alcohol swabs. • DME and medical supplies prescribed primarily for the convenience of the member or the member’s family, including but not limited to, duplicate DME or medical supplies for use in multiple locations or any DME or medical supplies used primarily to assist a caregiver. • Non-wearable automatic external defibrillators. • Replacement of durable medical equipment and prosthetic devices prescribed because of a desire for new equipment or new technology. • Equipment that does not meet the basic functional need of the average person. • DME that does not directly improve the function of the member. • Medical supplies provided during an office visit. • Pillows or batteries, except when used for the operation of a covered prosthetic device, or items for which the sole function is to improve the quality of life or mental wellbeing. • Repair or replacement of DME when the equipment is under warranty, covered by the manufacturer, or during the rental period. • Infant formula, nutritional supplements and food, or food products, whether or not prescribed, unless required by R.I. Law §27-20-56 for Enteral Nutrition Products, or delivered through a feeding tube as the sole source of nutrition. • Corrective or orthopedic shoes and orthotic devices used in connection with footwear, unless for the treatment of diabetes. Experimental or Investigational Services • Treatments, procedures, facilities, equipment, drugs, devices, supplies, or services that are experimental or investigational except as described in Section 3. Gender Reassignment Services • Reversal of gender reassignment surgery.

Time is Money Join Law Insider Premium to draft better contracts faster.