Outpatient Rehabilitative Services. Benefits will be provided for Outpatient Rehabilitative Services for the treatment of individuals who have sustained an illness or injury that CareFirst BlueChoice determines to be subject to improvement. The goal of Outpatient Rehabilitative Services is to return the individual to his/her prior skill and functional level.
Outpatient Rehabilitative Services. Benefits will be provided for Outpatient Rehabilitative Services for the treatment of individuals who have sustained an illness or injury that CareFirst determines to be subject to improvement. The goal of Outpatient Rehabilitative Services is to return the individual to his/her prior skill and functional level.
Outpatient Rehabilitative Services. Occupational therapy, speech therapy and physical therapy, provided to Members not admitted to a Hospital or related institution.
Outpatient Rehabilitative Services. Covered Services are paid according to the plan for the purpose of restoring certain functional losses due to Illness or Injury. Services are limited to 30-60 visits per Calendar Year depending on condition. (Limits do not apply for Mental Health and Substance Use Disorder Services.) Outpatient Services* – Covered Services for approved, Medically Necessary procedures, that can be performed safely on an outpatient basis are covered. Outpatient settings include Hospital outpatient departments, Ambulatory Surgical Centers and clinics. Outpatient Services may be subject to professional, and facility fees or Copays. Pain Management* – Covered Services provided as part of a pain management treatment plan or done within a pain management clinic are covered. Covered Services are paid according to the plan based on place of service, provider type, and provider billing. Pediatric Vision – Covered Services are paid according to the plan. Refer to the Pediatric Vision Benefits section. Physical Therapy* – Covered Services of a licensed physical therapist, are paid according to the plan. Services do not require a physician referral; Members can self-refer. We cover Medically Necessary therapy and Services for the treatment of traumatic brain injury. Physical, occupational, and Speech Therapy are covered up to a combined maximum of 30 visits per Calendar Year. These Services can be provided in both inpatient and outpatient settings and are referred to as Rehabilitative and Habilitative Services. Refer to your Schedule of Benefits for Cost Share information. Primary Care Provider (PCP) – Covered Services provided by a PCP are paid according to the plan. Professional Provider – Services of a Professional Provider are covered for diagnosis or Medically Necessary treatment of Illness or Injury, and for covered Preventive Services. Services that can be considered professional include, but are not limited to, PCP office visits, Specialist visits, care management Services, education Services, radiology and laboratory readings, and professional surgeon Services. Covered Services are paid according to the plan based on place of service, provider type, and provider billing. Refer to your Schedule of Benefits for Cost Share information. Professional Provider Visits in the Hospital* – Eligible Expenses include Professional Provider visits to you during a covered Hospital or Skilled Nursing Facility stay. We do not cover separately, visits relating to surgery performed during a Hosp...
Outpatient Rehabilitative Services. Occupational therapy Physical therapy Speech therapy (including specialty Hospitals, acute care Hospitals and providers of rehabilitation services) Here’s a list of the medications and supplies that also require Pre-Authorization.
Outpatient Rehabilitative Services. Short-term outpatient rehabilitation services, limited to: • Physical therapy. • Occupational therapy. • Speech therapy. • Cardiac rehabilitation therapy. Benefits include continuous EKG telemetric monitoring during exercise, EKG rhythm strip with interpretation, Physician's revision of exercise prescription, and follow up examination for Physician to adjust medication or change regimen. • Pulmonary rehabilitation therapy. For the purpose of this Benefit, "outpatient rehabilitation services" means occupational therapy, speech therapy, physical therapy, cardiac rehabilitation therapy and pulmonary rehabilitation therapy, provided to a Covered Person not admitted to a Hospital or Related Institution. For the purpose of this Benefit, "cardiac rehabilitation" is a comprehensive program involving medical evaluation, prescribed exercise, cardiac xxxx factor modification, education and counseling. Rehabilitation services must be performed by a Physician or by a licensed therapy provider. Benefits under this section include rehabilitation services provided in a Physician's office or on an outpatient basis at a Hospital or Alternate Facility. Benefits can be denied or shortened for Covered Persons who are not expected to progress further in goal-directed rehabilitation services or all rehabilitation goals have previously been met. Cardiac rehabilitation therapy and pulmonary rehabilitation therapy provided as maintenance programs are excluded as described in Section 2: Exclusions and Limitations. Benefits are provided for Medically Necessary speech therapy in adult Covered Persons who have lost speech due to Sickness or Injury, or for the treatment of a congenital or genetic defect. Benefits are provided for Medically Necessary speech therapy in Enrolled Dependent children who have lost speech or who have never gained speech due to Sickness, Injury or diagnosed developmental disorder.
