Outpatient procedures Sample Clauses

The 'Outpatient procedures' clause defines the terms and conditions under which medical procedures that do not require an overnight hospital stay are covered or managed within an agreement. Typically, this clause outlines which outpatient services are included, any pre-authorization requirements, and the extent of coverage or reimbursement for such procedures. By clearly specifying these details, the clause ensures that both parties understand their responsibilities and the scope of coverage, thereby reducing disputes and providing clarity regarding outpatient medical care.
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Outpatient procedures diagnostic and therapeutic medical services specified in the relevant Scope of Agreement, performed according to the medical indications, under local or infiltration anaesthesia, in the conditions of the treatment room of the outpatient institution (clinic), taking place on the basis of a referral issued by a physician of the Medicover Medical Facility. The service is not subject to the scope of outpatient procedures and will not be provided within this scope if due to the age or health condition of the person entitled to medical services and the change in the standards of service provision and guidelines for medical procedures, a specialist treatment room or other type of anaesthesia will be necessary for its effective and safe performance. Depending on the conditions necessary for the performance of the service, it will be treated as a highly specialised procedure, a 1- day surgery or a hospital service and can be performed according to the Scope of Agreement.
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