Alcohol Abuse. Abuse of or addiction to alcohol. Alcohol Abuse does not include abuse of or addiction to drugs. Please see the definition of Substance Abuse. [ALLOWED CHARGE. An amount that is not more than the [lesser of: • the] allowance for the service or supply as determined by Us based on a standard approved by the Board[; or [• the negotiated fee schedule.] The Board will decide a standard for what is considered an Allowed Charge under this Contract. For charges that are not determined by a negotiated fee schedule, the [Member] may be billed for the difference between the Allowed Charge and the charge billed by the Provider. Please note: The Coordination of Benefits and Services provision includes a distinct definition of Allowed Charge.] AMBULANCE. A certified transportation vehicle for transporting Ill or Injured people that contains all life-saving equipment and staff as required by applicable state and local law. AMBULATORY SURGICAL CENTER. A Facility mainly engaged in performing Outpatient Surgery. It must: be staffed by Practitioners and Nurses, under the supervision of a Practitioner; have operating and recovery rooms; be staffed and equipped to give emergency care; and have written back-up arrangements with a local Hospital for emergency care. It must carry out its stated purpose under all relevant state and local laws and be either: accredited for its stated purpose by either the Joint Commission or the Accreditation Association for ambulatory care; or approved for its stated purpose by Medicare. A Facility is not an Ambulatory Surgical Center, for the purpose of this Contract, if it is part of a Hospital.
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Samples: www.state.nj.us, www.state.nj.us, www.state.nj.us