Other Medical Services. In addition to PCPs, specialists, and hospitals, the network includes other health care professionals to meet your needs. If you need diagnostic testing, laboratory services or other health care services, your PCP or participating OB/GYN will coordinate your care or refer you to an appropriate setting. You may have to pay a copayment and any other applicable coinsurance or deductibles for some of these services, depending on your plan. Preventive care is a key part of your plan, which emphasizes staying healthy by covering: • Well-child care, including immunizations • Prenatal and postnatal care • Hearing loss screenings through 24 months • Periodic health assessments • Eye and ear screenings • Annual well-woman exams, including, but not limited to, a conventional Pap smear • Annual screening mammograms for females age 35 and over, or females with other risk factors • Bone mass measurement for osteoporosis • Prostate cancer screening for males at least age 50, or at least age 40 with a family history of prostate cancer • Colorectal cancer screening for persons 50 years of age and older • Depending on your plan, any other evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Task Force (“USPSTF”) or as required by state law. Your mental health benefits include outpatient and depending on your plan inpatient visits for crisis intervention and evaluation. Please refer to your COC for additional information. To access mental health services, call the designated behavioral health vendor listed on the back of your ID card. Depending on your plan, you may have coverage for prescription drugs. To find out which prescription drugs are covered under a plan, you can review the applicable drug list at xxx.xxxxxx.xxx/xxxxxx/xx_xxxxx.
Other Medical Services. In addition to PCPs, specialists, and hospitals, the network includes other health care professionals to meet your needs. If you need diagnostic testing, laboratory services or other health care services, your PCP or participating OB/GYN will coordinate your care or refer you to an appropriate setting. You may have to pay a copayment and any other applicable coinsurance or deductibles for some of these services, depending on your plan.
Other Medical Services. All other SoonerCare benefits (with the exception of non- emergency transportation and PACE, which are paid through a capitated contract) are paid through the state’s FFS system.
Other Medical Services. The charged amount of medical hours in connection with all other Medical Services is de- pendent on the time expenditure of the Health Professionals or is based on a flat fee for the respective Medical Service. The current prices for Fee-based Medical Services are published under: [here].
Other Medical Services. All other medical services in the Demonstration, with the exception of emergency transportation, which is paid through a capitated contract, are paid through the State’s FFS system.
Other Medical Services. 1. Inpatient medical care visits.
2. Inpatient Concurrent Care.
3. Inpatient Consultation (as defined in this Contract).
Other Medical Services. All other SoonerCare benefits, with the exception of
Other Medical Services. The Practice will also provide general internal medicine and cardiology services to you as a regular patient of the Practice, but such medical services will be arranged directly between you and the Practice, will be paid for by you directly, by your insurance company, or by Medicare (as the case may be) and are not covered by this Agreement. (As used in this Agreement, the term “Insurance Company” or “Insurance” will mean your private health insurance policy or your individual or group health plan, HMO, PPO, or other similar private health plan or coverage.) You or your Insurance Company (or Medicare, as the case may be) will be financially responsible to pay for all medical services. You acknowledge that the fee paid under this Agreement does not affect the co- payments, co-insurance, or deductibles that you are required to pay pursuant to the terms of any Insurance contract or medical coverage, including Medicare. You will continue to be responsible for any co-payments, co-insurance, and/or deductible amounts required by your Insurance coverage or Medicare for medical services.
Other Medical Services. In addition to PCPs, specialists, and hospitals, the network includes other health care professionals to meet your needs. If you need diagnostic testing, laboratory services or other health care services, your PCP or participating OB/GYN will coordinate your care or refer you to an appropriate setting. You may have to pay a copayment and/or any other applicable coinsurance or deductibles (if any) for some of these services, depending on your plan. Preventive Care Preventive care is a key part of your plan, which emphasizes staying healthy by covering: • Well-child care, including immunizations • Prenatal and postnatal care • Hearing loss screenings through 24 months • Periodic health assessments • Eye and ear screenings • Annual well-woman exams, including, but not limited to, a conventional Pap smear Sample • Annual screening mammograms for females over age 35, or females with other risk factors • Bone mass measurement for osteoporosis • Prostate cancer screening for males at least age 50, or at least age 40 with a family history of prostate cancer • Colorectal cancer screening for persons 50 years of age and older • Depending on your plan - Any other evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Task Force (“USPSTF”) or as required by state law. Behavioral Health Your behavioral health benefits include outpatient and (depending on your plan) inpatient visits for crisis intervention and evaluation. Please refer to your COC for additional information. To access behavioral health services, call the designated behavioral health vendor listed on the back of your ID card. Copayments /Coinsurance and Deductibles (if any) A copayment and/or any applicable coinsurance or deductible (if any) may be due at the time a participating provider renders service. Certain copayment amounts and/or any applicable coinsurance or deductible (if any) and the corresponding types of services are listed on your ID card. For a complete list, refer to the Schedule of Copayments and Benefit Limits in your COC. The copayment and/or any other coinsurance or deductible amount (if any) is determined by your plan. Usually, you are expected to pay nothing more than a copayment and/or any applicable coinsurance or deductible (if any) to participating providers. You should not receive a bill for services received from participating providers. If this occurs, call Customer Service to help determine if...
Other Medical Services. During the term of a Physician ---------------------- Member's Employment Agreement and thereafter subject to Section 8.1, a Physician Member shall not (directly or as an employee, shareholder, partner, consultant or otherwise) acquire. establish or commence the operation of any medical office, ambulatory surgery center, Integrated Health Service, optical shop, health maintenance organization. preferred provider organization, exclusive provider organization or similar entity or organization without the prior approval of the Joint Policy Board and PQC.
