Preferred Bariatric Surgery Services Provider a Pre- ferred Hospital or a Physician Member that has contracted with Blue Shield of California to furnish bariatric surgery Services and accept reimbursement at negotiated rates, and that has been designated as a contracted bariatric surgery Services provider by Blue Shield of California. Preferred Dialysis Center – a dialysis services facility which has contracted with Blue Shield of California to pro- vide dialysis services on an Outpatient basis and accept xxxx- bursement at negotiated rates. Preferred Hospital — a Hospital which has contracted with Blue Shield of California to furnish Services and accept re- imbursement at negotiated rates, and which has been desig- nated as a Preferred Hospital by Blue Shield of California. Preferred Physicians — a Physician who has agreed to ac- cept Blue Shield of California's payment, plus Subscriber payments of any applicable Deductible and/or Copayments as payment-in-full for covered Services. Please refer to the Summary of Benefits for Copayment information Preferred Provider - A Preferred Provider is a Participating Provider contracted with Blue Shield of California to furnish Services and to accept Blue Shield of California's payment, except for applicable Deductibles, copayments, or amounts in excess of specified benefit maximums, and except as provid- ed under the section entitled Preventive Care Benefits. Note, for Participating Providers for Mental Health Services, see the Mental Health Service Administrator (MHSA) Partici- pating Providers definitions. Skilled Nursing Facility — a facility licensed by the Cali- fornia Department of Health Services as a "Skilled Nursing Facility" or any similar institution licensed under the laws of any other state, territory, or foreign country. All Other Definitions Whenever any of the following terms are capitalized in this booklet, the terms will have the meaning as indicated below: Accidental Injury — definite trauma resulting from a sud- den, unexpected and unplanned event, occurring by chance, caused by an independent external source. Activities of Daily Living (ADL) — mobility skills required for independence in normal everyday living. Recreational, leisure, or sports activities are not included. Acute Care — care rendered in the course of treating an ill- ness, injury or condition marked by a sudden onset or change of status requiring prompt attention, which may include hos- pitalization, but which is of limited duration and which is not expected to last indefini...
Preferred Bariatric Surgery Services Provider a Pre- ferred Hospital or a Physician Member that has contracted with Blue Shield to furnish bariatric surgery Services and accept reimbursement at negotiated rates, and that has been designated as a contracted bariatric surgery Services pro- vider by Blue Shield. Preferred Dialysis Center — a dialysis services facility which has contracted with Blue Shield to provide dialysis Services on an Outpatient basis and accept reimbursement at negotiated rates. Preferred Hospital — a Hospital under contract to Blue Shield which has agreed to furnish Services and accept re- imbursement at negotiated rates, and which has been desig- nated as a Preferred Hospital by Blue Shield. Note: For Participating Providers for Mental Health Ser- vices, see the MHSA Participating Provider definition above. Preferred Provider — a Physician Member, Preferred Hospital, Preferred Dialysis Center, or Participating Pro- vider. Note: For Participating Providers for Mental Health Services, see the MHSA Participating Provider definition above. Skilled Nursing Facility — a facility with a valid license issued by the California Department of Health Services as a Skilled Nursing Facility or any similar institution licensed under the laws of any other state, territory, or foreign coun- try. All Other Definitions Whenever any of the following terms are capitalized in this booklet, they will have the meaning stated below: Accidental Injury — definite trauma resulting from a sud- den, unexpected and unplanned event, occurring by chance, caused by an independent, external source.
Preferred Bariatric Surgery Services Provider a Pre- ferred Hospital or a Physician Member that has contracted with Blue Shield to furnish bariatric surgery Services and accept reimbursement at negotiated rates, and that has been designated as a contracted bariatric surgery Services provider by Blue Shield. Preferred Dialysis Center — a dialysis services facility which has contracted with Blue Shield to provide dialysis services on an Outpatient basis and accept reimbursement at negotiated rates. Preferred Free-Standing Laboratory Facility (Laborato- ry Center) — a free-standing facility which is licensed sepa- rately and bills separately from a Hospital and is not other- wise affiliated with a Hospital, and which has contracted with Blue Shield to provide laboratory services on an Outpatient basis and accept reimbursement at negotiated rates. Preferred Free-Standing Radiology Facility (Radiology Center) — a free-standing facility which is licensed sepa- rately and bills separately from a Hospital and is not other- wise affiliated with a Hospital, and which has contracted with Blue Shield to provide radiology services on an Outpatient basis and accept reimbursement at negotiated rates. Preferred Hemophilia Infusion Provider — a provider that has contracted with Blue Shield to furnish blood factor re- placement products and services for in-home treatment of blood disorders such as hemophilia and accept reimburse- ment at negotiated rates, and that has been designated as a contracted Hemophilia Infusion Provider by Blue Shield.
