Surgery - Outpatient Sample Clauses

Surgery - Outpatient. Surgery and related services received on an outpatient basis at a Hospital or Alternate Facility or in a Physician's office. Benefits include certain scopic procedures. Examples of surgical scopic procedures include: • Arthroscopy. • Laparoscopy. • Bronchoscopy. • Hysteroscopy. Benefits include: • The facility charge and the charge for supplies and equipment. • Physician services for radiologists, anesthesiologists and pathologists. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.) Tissue transplants and cornea transplants when ordered by a Physician. Benefits are available for tissue and cornea transplants when the transplant meets the definition of a Covered Health Care Service, and is not an Experimental or Investigational or Unproven Service. You can call us at the telephone number on your ID card for information regarding Benefits for tissue and cornea transplant services.
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Surgery - Outpatient. Surgery and related services received on an outpatient basis at a Hospital or Alternate Facility or in a Physician's office. Benefits include certain scopic procedures. Examples of surgical scopic procedures include: • Arthroscopy. • Laparoscopy. • Bronchoscopy. • Hysteroscopy. Benefits include: • The facility charge and the charge for supplies and equipment. • Physician services for radiologists, anesthesiologists and pathologists. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.) • Voluntary male sterilization and associated anesthesia. Tissue transplants and cornea transplants when ordered by a Physician. Benefits are available for tissue and cornea transplants when the transplant meets the definition of a Covered Health Care Service, and is not an Experimental or Investigational or Unproven Service. You can call us at the telephone number on your ID card for information regarding Benefits for tissue and cornea transplant services.
Sample 1Sample 2
Surgery - Outpatient. Surgery and related services received on an outpatient basis at a Hospital or Alternate Facility or in a Physician's office. Benefits include certain scopic procedures. Examples of surgical scopic procedures include: • Arthroscopy. • Laparoscopy. • Bronchoscopy. • Hysteroscopy. • Routine circumcision. • Voluntary termination of pregnancy (abortion). SAMPLE • Sterilization procedure for a female member when performed as the primary procedure for family planning reasons. • Anesthesia services that are related to covered surgery. This includes those services that are furnished for you by a Physician other than the attending Physician; or by a certified registered nurse anesthetist. Examples of surgical procedures performed in a Physician's office are mole removal, ear wax removal, and cast application. Benefits include: • The facility charge and the charge for supplies and equipment. • Physician services for radiologists, anesthesiologists and pathologists. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.)
Sample 1
Surgery - Outpatient. Surgery and related services received on an outpatient basis at a Hospital or Alternate Facility or in a Physician's office. Benefits include certain scopic procedures. Examples of surgical scopic procedures include: • Arthroscopy. • Laparoscopy. • Bronchoscopy. • Hysteroscopy. Benefits include: • The facility charge and the charge for supplies and equipment. SAMPLE • Physician services for radiologists, anesthesiologists and pathologists. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.) • Voluntary male sterilization and associated anesthesia. Tissue transplants and cornea transplants when ordered by a Physician. Benefits are available for tissue and cornea transplants when the transplant meets the definition of a Covered Health Care Service, and is not an Experimental or Investigational or Unproven Service. You can call us at the telephone number on your ID card for information regarding Benefits for tissue and cornea transplant services. Benefits for bone-anchored hearing aids are available to Covered Persons, and are limited to one hearing instrument per hearing impaired ear every 24 months. Benefits include repairs and/or replacement of a hearing instrument when Medically Necessary. Benefits include: • Surgical removal of complete bony impacted teeth. • Excision of tumors or cysts of the jaws, cheeks, lips, tongue, roof and floor of the mouth. • Surgical procedures to correct accidental injuries of the jaws, cheeks, lips, tongue, roof and floor of the mouth. • Excision of exostoses of the jaws and hard palate (provided that this procedure is not done in preparation for dentures or other prostheses); treatment of fractures of facial bone; external incision and drainage of cellulitis; incision of accessory sinuses, salivary glands or ducts.
Sample 1
Surgery - Outpatient. Surgery and related services received on an outpatient basis at a Hospital or Alternate Facility or in a Physician's office. Benefits include certain scopic procedures. Examples of surgical scopic procedures include: • Arthroscopy. • Laparoscopy. • Bronchoscopy. • Hysteroscopy. • Routine circumcision. • Voluntary termination of pregnancy (abortion). • Sterilization procedure for a female member when performed as the primary procedure for family planning reasons. • Anesthesia services that are related to covered surgery. This includes those services that are furnished for you by a physician other than the attending physician; or by a certified registered nurse anesthetist. Benefits include: • The facility charge and the charge for supplies and equipment. • Physician services for radiologists, anesthesiologists and pathologists. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.)
Sample 1
Surgery - Outpatient. Surgery and related services received on an outpatient basis at a Hospital or Alternate Facility or in a Physician's office. Benefits include certain scopic procedures. Examples of surgical scopic procedures include: • Arthroscopy. • Laparoscopy. • Bronchoscopy. • Hysteroscopy. Benefits include: • The facility charge and the charge for supplies and equipment. • Physician services for radiologists, anesthesiologists and pathologists. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.) • Therapeutic surgical abortion recommended by a Provider and performed to save the life of the mother or as a result of incest or rape. Depending on where a non-surgical abortion is administered, Benefits will be provided for under the corresponding Benefit category in this Policy. Tissue transplants and cornea transplants when ordered by a Physician. Benefits are available for tissue and cornea transplants when the transplant meets the definition of a Covered Health Care Service, and is not an Experimental or Investigational or unproven service. You can call us at the telephone number on your ID card for information regarding Benefits for tissue and cornea transplant services.
Sample 1

Related to Surgery - Outpatient

  • 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

  • Inpatient If you are an inpatient in a general or specialty hospital for mental health services, this agreement covers medically necessary hospital services and the services of an attending physician for the number of hospital days shown in the Summary of Medical Benefits. See Section

  • 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.

  • 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.

  • 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.

  • Diagnostic procedures to aid the Provider in determining required dental treatment.

  • Ambulance Escort Where a nurse is assigned to provide patient care for a patient in transit, the following provisions shall apply: i) Where a full-time nurse performs such duties during her or his regular shift, the full-time nurse shall be paid her or his regular rate of pay. Where a full-time nurse performs such duties outside her or his regular shift or on a day off, she or he shall be paid the appropriate overtime rate. ii) Where a part-time nurse performs such duties during an assigned shift, she or he shall be paid her or his regular rate of pay. Where a part-time nurse continues to perform such duties in excess of her or his assigned shift, she or he shall be paid the appropriate overtime rate. (b) Where such duties extend beyond the nurse's regular shift, the Hospital will not require the nurse to return to regular duties at the hospital without at least eight (8) hours of time off. Where such time off extends into the nurse's next regularly scheduled shift she or he will maintain her or his regular earnings for that full shift. (c) Hours spent between the time the nurse is relieved of patient care responsibilities and the time the nurse returns to the hospital or to such other location agreed upon between the Hospital and the nurse will be paid at straight time or at appropriate overtime rates, if applicable under Article 14. 01. It is understood that the nurse shall return to the hospital or to such other location agreed upon between the Hospital and the nurse at the earliest opportunity. Prior to the nurse's departure on escort duty, or at such other time as may be mutually agreed upon between the Hospital and the nurse, the Hospital will establish with the nurse arrangements for return travel. (d) The nurse shall be reimbursed for reasonable out of pocket expenses including room, board and return transportation and consideration will be given to any special circumstances not dealt with under the foregoing provisions. NOTE 1: (Note 1 applies to full-time nurses only) The Hospital agrees to continue to pay any greater monetary benefit for ambulance escort duty if such greater benefit has been paid by the Hospital immediately prior to this Agreement. This note applies at Hospitals where this superior condition exists as of December 14, 1987. NOTE 2: (Note 2 applies to part-time nurses only) The Hospital agrees to continue to pay any greater monetary benefit for ambulance escort duty if such greater benefit was paid by the Hospital under a Collective Agreement immediately prior to this Agreement. This note applies at Hospitals where this superior condition exists as of December 14, 1987.

  • Hospital This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Ambulance The deductible and coinsurance for services not subject to copays applies.

  • Prosthodontics We Cover prosthodontic services as follows:

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