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, Pregnancy or Mental Illness, except as specifically provided.
