Outpatient Medical Services Sample Clauses

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).
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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).
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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. a. Home, Office and Other Outpatient Visits Visits and consultation for the examination, diagnosis, and treatment of an injury or illness.
Sample 1
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).
Sample 1
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).
Sample 1
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).
Sample 1
Outpatient Medical Services 
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Related to Outpatient Medical Services

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

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

  • Medical Services Plan Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. The City shall pay one hundred percent (100%) of the premiums required by the plan.

  • 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. This plan covers dental care for members until the last day of the month in which they turn nineteen (19). This plan covers services only if they meet all of the following requirements: • listed as a covered dental care service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered dental care service under this plan. • dentally necessary, consistent with our dental policies and related guidelines at the time the services are provided. • not listed in Exclusions section. • received while a member is enrolled in the plan. • consistent with applicable state or federal law. • services are provided by a network provider.

  • Outpatient Services Physicians, Urgent Care Centers and other Outpatient Providers located outside the BlueCard® service area will typically require You to pay in full at the time of service. You must submit a Claim to obtain reimbursement for Covered Services.

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • Outpatient If you receive infusion therapy services in a hospital's outpatient unit, we cover the use of the treatment room, related supplies, and solutions. For prescription drug coverage, see Section 3.27

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.

  • Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. This plan covers respiratory therapy services. When respiratory services are provided in your home, as part of a home care program, durable medical equipment, supplies, and oxygen are covered as a durable medical equipment service.