Outpatient Medical Services. This benefit has one or more exclusions as specified in the Exclusions Section. Outpatient Medical Services are services provided in a Hospital, outpatient facility, Practitioner’s/Provider’s office or other appropriately licensed facility. These services do not require admission to any facility. Outpatient Medical services include reasonable Hospital services provided on an ambulatory (outpatient) basis and those preventive, Medically Necessary diagnostic and treatment procedures that are prescribed by your In-network Practitioner/Provider. Refer to the Prior Authorization Section for services that require Prior Authorization. Outpatient services provided by Out-of-network Providers/Practitioners are not Covered except as provided in How the Plan Works, Eligibility and Enrollment, and Accidental Injury / Urgent Care / Emergency Health Services / Observation / Trauma Services Benefit Sections. Outpatient Medical benefits include, but are not limited to, the following services: • Chemotherapy and radiation therapy - Chemotherapy is the use of chemical agents in the treatment or control of disease. • Hypnotherapy (Limited) - Hypnotherapy is only Covered when performed by an anesthesiologist or psychiatrist, trained in the use of hypnosis when: Used within two weeks prior to surgery for chronic pain management and For chronic pain management when part of a coordinated treatment plan. • Dialysis • Diagnostic Services – Refer to the Diagnostic Services Section • Medical Drugs (Medications obtained through the medical benefit).
Outpatient Medical Services. Outpatient Medical Services are services provided in a Hospital, outpatient facility, Practitioner’s/Provider’s office or other appropriately licensed facility. These services do not require admission to any facility. Outpatient Medical services include reasonable Hospital services provided on an ambulatory (outpatient) basis and those diagnostic and treatment procedures that are prescribed by your attending Practitioner/Provider. Refer to the Prior Authorization Section for services that require Prior Authorization. Outpatient Medical benefits include, but are not limited to, the following services: • Chemotherapy and radiation therapy - Chemotherapy is the use of chemical agents in the treatment or control of disease. • Hypnotherapy (Limited) - Hypnotherapy is only Covered when performed by an anesthesiologist or psychiatrist, trained in the use of hypnosis when: o Used within two weeks prior to surgery for chronic pain management and o For chronic pain management when part of a coordinated treatment plan. • Dialysis • Diagnostic Services – Refer to the Diagnostic Services Section • Medical Drugs (Medications obtained through the medical benefit).
Outpatient Medical Services. Medical Care rendered by a Physician or other Provider to an Insured who is an Outpatient for a condition not related to Surgery, or Mental Illness, except as specifically provided.
a. Home, Office and Other Outpatient Visits - Visits and consultation for the examination, diagnosis, and treatment of an injury or illness.
Outpatient Medical Services. This benefit has one or more exclusions as specified in the Exclusions Section. Outpatient Medical Services are services provided in a Hospital, outpatient facility, Practitioner’s/Provider’s office or other appropriately licensed facility. These services do not require admission to any facility. Outpatient Medical services include reasonable Hospital services provided on an ambulatory (outpatient) basis and those preventive, Medically Necessary diagnostic and treatment procedures that are prescribed by your In-network Practitioner/Provider. Refer to the Prior Authorization Section for services that require Prior Authorization. Facility fees are determined by the facility providing the service. Members can inquire from the facility what the charge would be prior to receiving service and they can also receive an estimate for the cost of the service by using Presbyterian's treatment cost estimator tool. If a member receives unexpected charges, member should refer to their surprise billing rights in the member handbook and their explanation of benefits if it’s determined to be a surprise billing charge. Outpatient services provided by Out-of-network Providers/Practitioners are not Covered except as provided in How the Plan Works, Eligibility and Enrollment, and Accidental Injury (Trauma)/ Urgent Care / Emergency Health Services / Observation Benefit Sections. Outpatient Medical benefits include, but are not limited to, the following services: • Chemotherapy and radiation therapy - Chemotherapy is the use of chemical agents in the treatment or control of disease. • Hypnotherapy (Limited) - Hypnotherapy is only Covered when performed by an anesthesiologist or psychiatrist, trained in the use of hypnosis when: Used within two weeks prior to surgery for chronic pain management and for chronic pain management when part of a coordinated treatment plan. • Dialysis. • Diagnostic Services – refer to the Diagnostic Services Section. • Medical Drugs (Medications obtained through the medical benefit).
Outpatient Medical Services. This benefit has one or more exclusions as specified in the Exclusions Section. Outpatient Medical Services are services provided in a Hospital, outpatient facility, Practitioner’s/Provider’s office or other appropriately licensed facility. These services do not require admission to any facility. Outpatient Medical services include reasonable Hospital services provided on an ambulatory (outpatient) basis and those preventive, Medically Necessary diagnostic and treatment procedures that are prescribed by your In-network Practitioner/Provider. Refer to the Prior Authorization Section for services that require Prior Authorization. Outpatient services provided by Out-of-network (outside of the 5-county area) Providers/Practitioners are not Covered except as provided in How the Plan Works, Eligibility and Enrollment, and Accidental Injury / Urgent Care / Emergency Health Services / Observation / Trauma Services Benefit Sections. Outpatient Medical benefits include, but are not limited to, the following services: • Chemotherapy and radiation therapy - Chemotherapy is the use of chemical agents in the treatment or control of disease. • Hypnotherapy (Limited) - Hypnotherapy is only Covered when performed by an anesthesiologist or psychiatrist, trained in the use of hypnosis when: Used within two weeks prior to surgery for chronic pain management and for chronic pain management when part of a coordinated treatment plan. • Dialysis • Diagnostic Services – Refer to the Diagnostic Services Section • Medical Drugs (Medications obtained through the medical benefit).
Outpatient Medical Services. This benefit has one or more exclusions as specified in the Exclusions Section. Outpatient Medical Services are services provided in a Hospital, outpatient facility, Practitioner’s/Provider’s office or other appropriately licensed facility. These services do not require admission to any facility. Outpatient Medical services include reasonable Hospital services provided on an ambulatory (outpatient) basis and those preventive, Medically Necessary diagnostic and treatment procedures that are prescribed by your In-network Practitioner/Provider. Refer to the Prior Authorization Section for services that require Prior Authorization. Outpatient services provided by Out-of-network Providers/Practitioners are not Covered except as provided in How the Plan Works, Eligibility and Enrollment, and Accidental Injury (Trauma)/ Urgent Care / Emergency Health Services / Observation Benefit Sections. Outpatient Medical benefits include, but are not limited to, the following services: • Chemotherapy and radiation therapy - Chemotherapy is the use of chemical agents in the treatment or control of disease. • Hypnotherapy (Limited) - Hypnotherapy is only Covered when performed by an anesthesiologist or psychiatrist, trained in the use of hypnosis when: Used within two • Dialysis • Diagnostic Services – Refer to the Diagnostic Services Section • Medical Drugs (Medications obtained through the medical benefit).
Outpatient Medical Services
