Practitioner Services Sample Clauses

Practitioner Services. Charges for the services of the following Duly Licensed practitioners will be eligible. Unless specifically stated in the benefit booklet (as posted on the Board's intranet site), no benefits will be payable for tests, completion of reports or consultations with any person other than a Covered Person. A Physician's written authorization is only required for practitioner services where specified below. Physiotherapist or Certified Athletic Therapist (The services of a physiotherapist who has an agreement with the provincial health insurance plan will not be covered) Clinical Psychologist or Marriage and Family Therapist, up to a maximum of $500 per Covered Person in a calendar year Massage Therapist, up to a maximum of $500 per Covered Person in a calendar year Speech Pathologist, up to a maximum of $350 per Covered Person in a calendar year Chiropractor*, Osteopath, Podiatrist*, Chiropodist or Naturopath, up to a maximum of $500 per Covered Person per practitioner in a calendar year. This limit will include coverage for one x-ray taken by each practitioner each calendar year for each Covered Person.
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Practitioner Services. The Health Plan shall provide medically necessary practitioner services in accordance with the Practitioner Services Coverage and Limitations Handbook, and including the limitations and requirements specified below. a. Primary Care Services (1) The Health Plan shall process claims for and, if capitated or are approved by the Agency to subcapitate for certain covered services, pay certain physicians who provide Florida Medicaid-covered eligible primary care services in accordance with sections 1902(a)(13), 1902(jj), 1932(f), and 1905(dd) of the Social Security Act, as amended by the Affordable Care Act and 42 CFR sections 438, 441 and 447, for dates of service on or after January 1, 2013, through December 31, 2014. This provision also applies to any payments made through subcapitation arrangements. For Health Plans with subcapitation arrangements, the Agency recommends that the Health Plan implement a physician payment increase methodology similar to the Agency’s payment methodology approved by federal CMS. For purposes of sub-item 23., the term capitated Health Plan includes FFS PSNs approved to subcapitate for services. (2) The capitated Health Plan shall ensure the physician payment specified in this section applies to such primary care services provided by physicians with a specialty designation of family medicine, general internal medicine, or pediatric medicine or related subspecialists. Physicians affected include the following: (a) A physician as defined in 42 CFR 440.50; or provider under the personal supervision of a physician who self-attests to a specialty designation of family medicine, general internal medicine or pediatric medicine; or a subspecialty recognized by the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS) or the American Osteopathic Association (AOA); and (b) A physician who self-attests that he/she is board certified with such a specialty or subspecialty and/or has furnished evaluation and management services and vaccine administration services under the codes listed below that equal at least sixty percent (60%) of the Medicaid codes he or she has billed during the most recently completed calendar year or, for newly eligible physicians, the prior month. (3) The Health Plan shall ensure that increased payments specified in this provision are not provided to physicians delivering primary care services at FQHCs, RHCs or CHDs. (4) The capitated Health Plan shall make increased physician ...
Practitioner Services. OLPG, by and through HSC-S Faculty, shall provide the following health care professional services: (1) professional medical services to and for patients at Hospitals, including medically indigent and uninsured patients, as defined by Louisiana law (“Professional Services”); and (2) on call coverage services to the Hospitals (“On Call Coverage”). Collectively, Professional Services and On Call Coverage shall be referred to as “Practitioner Services.”
Practitioner Services. Practitioner I description of the orthopedic shoe and modification(s) is required. Boots, sandals or sport-specific footwear are not eligible. 80% to a benefit maximum of $300 per participant per Practitioner I Services are provided to a combined benefit maximum per participant per benefit year. The services of an occupational therapist must be prescribed by a physician or nurse practitioner. Practitioner II Practitioner II Services are provided to a combined benefit maximum per participant per benefit year. The services of a massage therapist or nutritional counsellor must be prescribed by a physician or nurse practitioner.
Practitioner Services. Charges for the services of the following Duly Licensed practitioners will be eligible. specifically stated, no benefits will be payable for tests, completion of reports or consultations with any person other than a Covered Person. A Physician’s written authorization is only required for practitioner services where specified below. Physiotherapist or Certified Athletic Therapist, up to a combined maximum of per Covered Person in a calendar year. (The services of a physiotherapist who has an agreement with provincial health insurance plan will not be covered.) Clinical Psychologist or Marriage and Family Therapist, up to a combined maximum of per Covered Person in a calendar year. Massage Therapist, up to a maximum of per Covered Person in a calendar year. (These services must be authorized in writing by the Covered Person’s attending Physician.) Speech Pathologist, up to a maximum of per Covered Person in a calendar year. Chiropractor*, Osteopath*, Podiatrist*, Chiropodist or Naturopath, up to a maximum of per Covered Person per practitioner in a calendar year. Benefits are also payable for x-rays taken by a chiropractor, osteopath or podiatrist, up to a maximum of per Covered Person per practitioner in a calendar year. for the these practitioners will be made any annual allowance under the health insuranceplan has been exhausted. Charges for: Drugs, and injected allergy sera which: are listed in Manulife Financial Formulary Three, are purchased on the prescription of a Physician or Dentist, and are dispensed by a Duly Licensed pharmacist, Physician, Dentist or Hospital. This includes extemporaneous preparations provided at least one of the ingredients is Drugs and medicines considered to be life sustaining (as determined by Manulife ’Financial) when purchased on the prescription of a physician or dentist and dispensed by a Duly Licensed pharmacist, physician, dentist or hospital. This includes extemporaneous preparations provided at least one of the ingredients is drugs, up to a of per Covered Person per calendar year. Insulin, needles, syringes and chemical testing agents for the management of Injected vitamins. Sclerotherapy drugs for varicose vein treatment. cessation aids, up to a three month supply per calendar year (204 tablets is the equivalent of a three month supply) and limited to two three month per Covered Person’s lifetime. For a Covered Person years of and older, charges for the following expenses which are no longer payable under a Governme...

Related to Practitioner Services

  • 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.

  • Provider Services Charges for the following Services when ordered by a Physician for the treatment of an Injury or Illness.

  • REGULATORY ADMINISTRATION SERVICES BNY Mellon shall provide the following regulatory administration services for each Fund and Series:  Assist the Fund in responding to SEC examination requests by providing requested documents in the possession of BNY Mellon that are on the SEC examination request list and by making employees responsible for providing services available to regulatory authorities having jurisdiction over the performance of such services as may be required or reasonably requested by such regulatory authorities;  Assist with and/or coordinate such other filings, notices and regulatory matters and other due diligence requests or requests for proposal on such terms and conditions as BNY Mellon and the applicable Fund on behalf of itself and its Series may mutually agree upon in writing from time to time; and

  • Counseling Services Your first appointment (or more, in some cases) will involve an assessment of your needs. By the end of the assessment your counselor will be able to offer you some first impressions of what your work may include and recommendations for getting help. One of the recommendations may be psychotherapy. If so, ABO may or may not be able to provide you with psychotherapy, depending on your overall needs. If psychotherapy or any other recommendations suggested by your counselor include things that ABO cannot provide, you will be given suggestions of where you might receive those services. Wherever you choose to obtain treatment, you should evaluate the information from your initial assessment along with your own opinions of what sort of treatment you are willing to do and whether you feel comfortable working with the treating clinician. Therapy involves a large commitment of time, energy, and often money, so you should be very careful about the counselor you select. If you have questions about the procedures used or conclusions made by your counselor at ABO, please discuss them whenever they arise. If your doubts persist, your counselor will be happy to help you set up a meeting with another mental health professional for a second opinion. Psychotherapy is not easily described in general statements. It varies depending on the particular problems you are experiencing, the therapeutic methods used by your counselor, and the personalities of the counselor and client. There are many different methods counselors may use to deal with the problems that you hope to address. Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things that are discussed both during your sessions and on your own. Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, shame, frustration, loneliness, and helplessness. The changes you make in therapy may also affect your relationships in unexpected ways. Psychotherapy has also been shown to have many benefits. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience. The initial assessment will last from one to four sessions. During this time, you and your counselor can both decide if she/he is the best person to provide the services you need in order to meet your treatment goals. If you choose to begin psychotherapy, your counselor will usually schedule one meeting at a time you each agree on. Once an appointment is scheduled, you will be expected to attend unless you provide advance notice of cancellation. If you need to cancel an appointment, it is your responsibility to contact us to cancel. Fees will be collected when services are rendered.*In addition to therapy services fees may include assessment administration, scoring, and reporting; creating reports; creating copies of records on request; and consulting with other professionals at the client’s request. There will be an additional $25 fee assessed for any returned check. We understand that there are unforeseeable circumstances like sick children or bad weather. Your appointment is important though, and your therapist is happy to contact you for a phone session or a session via our HIPPA-compliant virtual therapy system so you don't need to leave your sick child or worry about traffic and weather. As long as you are in a confidential location, we can help you keep your regularly scheduled appointment. If you still must change or cancel your counseling appointment, please know: • Cancellations must be made during business hours. • Cancellations must be made within 48 hours of session time if using our online scheduling program. • We cannot accommodate cancellations made via email as we do not monitor email on a regular basis. • We may not accommodate cancellations made after hours or on holidays to our main number as we cannot check voice mail regularly. If you have an appointment on a Monday or the first day following a holiday, you must make your change or cancellation the last business day before your appointment. • Cancellations with less than 24 hours’ notice will result in a fee equal to the total amount of the missed session that will be collected at your next appointment, or, if payment information is on file, it will be debited from your credit card. • *After two no-shows/late cancellations, you will pre-pay a retainer before scheduling any future appointments. • Clients who have pre-paid agree to have the entire fee deducted from their pre-payment in cases of other no-shows and late changes/cancellations. • Court testimony costs begin at $250 per hour with a minimum charge of three hours. A retainer of $1000 is due one week prior to the court date. Travel is billed at .55/mile. Failure to provide the specific fees as described constitutes a release from the requested court appearance. • It is required that a minimum of 36 hours’ notice be given if the testimony is not required, otherwise the entire retainer may be forfeited. If proper notice is given, the retainer will be refunded. • Additional services related to court preparation including all correspondence with attorneys or other service providers via phone, email, or letter, documentation review and/or documentation preparation are also billed at $250 per hour, rounded to the nearest 15 minute increment. You (not your insurance company) are responsible for full payment of fees. It is very important that you find out exactly what mental health services your insurance policy covers. You must pay your xxxx first, then contact your insurance company regarding reimbursement. We answer our main office number 9:00 AM – 5:00 PM Monday through Friday (except holidays). You may have your counselor’s cell phone number in order to coordinate administrative tasks (defined as appointment arrival, appointment time, and directions). Email, and text messaging are not secure mediums in terms of privacy and confidentiality so our policy regarding, electronic communication, and cell phone use includes the following: • We do not provide therapy/counseling via email or text messaging. • Text messaging and email will be used for administrative tasks only (as defined above). • Therapists may not acknowledge or return emails or text messages that are not administrative. This includes emergency texts and emails. • If your therapist leaves for an extended period of time you will be given the information for another licensed therapist with whom you may schedule if you need an appointment during your therapist’s absence. You may need to fill out other paperwork if therapist is in another practice.

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

  • Legal Services If this Agreement is for legal services, this section is applicable. Contractor shall: (i) adhere to legal cost and billing guidelines designated by the JBE; (ii) adhere to litigation plans designated by the JBE, if applicable; (iii) adhere to case phasing of activities designated by the JBE, if applicable; (iv) submit and adhere to legal budgets as designated by the JBE; (v) maintain legal malpractice insurance in an amount not less than the amount designated by the JBE; and (vi) submit to legal bill audits and law firm audits if so requested by the JBE, whether conducted by employees or designees of the JBE or by any legal cost-control provider retained by the JBE for that purpose. Contractor may be required to submit to a legal cost and utilization review as determined by the JBE. If (a) the Contract Amount is greater than $50,000, (b) the legal services are not the legal representation of low- or middle-income persons, in either civil, criminal, or administrative matters, and (c) the legal services are to be performed within California, then Contractor agrees to make a good faith effort to provide a minimum number of hours of pro xxxx legal services, or an equivalent amount of financial contributions to qualified legal services projects and support centers, as defined in section 6213 of the Business and Professions Code, during each year of the Agreement equal to the lesser of either (A) thirty (30) multiplied by the number of full time attorneys in the firm’s offices in California, with the number of hours prorated on an actual day basis for any period of less than a full year or (B) the number of hours equal to ten percent (10%) of the Contract Amount divided by the average billing rate of the firm. Failure to make a good faith effort may be cause for nonrenewal of this Agreement or another judicial branch or other state contract for legal services, and may be taken into account when determining the award of future contracts with a Judicial Branch Entity for legal services.

  • Anesthesia Services This plan covers general and local anesthesia services received from an anesthesiologist when the surgical procedure is a covered healthcare service. This plan covers office visits or office consultations with an anesthesiologist when provided prior to a scheduled covered surgical procedure.

  • 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.

  • Contract for Professional Services of Physicians, Optometrists, and Registered Nurses In accordance with Senate Bill 799, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 2254.008(a)(2) is applicable to this Contract, Contractor affirms that it possesses the necessary occupational licenses and experience.

  • Educational Services Any service or supply for education, training or retraining services or testing including: special education, remedial education; cognitive remediation; wilderness/outdoor treatment, therapy or adventure programs (whether or not the program is part of a Residential Treatment facility or otherwise licensed institution); job training or job hardening programs; educational services and schooling or any such related or similar program including therapeutic programs within a school setting.

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