Hospital Services — Inpatient a. Inpatient Services are Medically Necessary services ordinarily furnished by a State licensed acute care Hospital for the medical care and treatment of inpatients provided under the direction of a physician or dentist in a Hospital maintained primarily for the care and treatment of patients with disorders other than mental diseases. Inpatient psychiatric Hospital services are Medically Necessary Behavioral Health Care Services and may be provided in a general Hospital psychiatric unit or in a specialty Hospital.
Hospital Services — Inpatient. Semi-Private Room Charges/Days of Hospital Coverage If you are hospitalized as an inpatient in a xxxx or semi-private room in a general hospital for medical or surgical services, we cover hospital services for the number of days listed in the Summary of Benefits. Coverage for physical rehabilitation services received in a specialty hospital or in a general hospital is limited to the number of days listed in the Summary of Benefits. If you are readmitted to the same or any other hospital within ninety (90) days after the date of a previous discharge, we will consider these admissions to fall within the same period of hospitalization when determining the number of hospital days available to you. If you are readmitted after ninety (90) days, we consider this to be a new period of hospitalization for the purpose of determining the hospital days available to you.
Hospital Services — Inpatient a. Inpatient services are medically necessary services ordinarily furnished by a state- licensed acute care hospital for the medical care and treatment of inpatients provided under the direction of a physician or dentist in a hospital maintained primarily for the care and treatment of patients with disorders other than mental diseases. AHCA Contract No. FA913, Attachment II, Page 71 of 186 AMERIGROUP Florida, Inc. d/b/a Medicaid Non-Reform and Reform AMERIGROUP Community Care HMO Contract
Hospital Services — Inpatient. Semi-Private Room Charges/Days of Hospital Coverage We cover inpatient hospital services in a xxxx or semi-private room in a general hospital for medical or surgical services. Coverage for physical rehabilitation services received in a specialty hospital or in a general hospital is limited to the number of days shown in the Summary of Medical Benefits. Preauthorization is recommended for this service. If you are readmitted to the same or any other hospital, within ninety (90) days after the date of a previous discharge, we will consider these admissions to fall within the same period of hospitalization. We use this time period when figuring out the number of physical rehabilitative days available to you. If you are readmitted after ninety (90) days, we consider this to be a new period of hospitalization for the purpose of determining the hospital days available to you. Hospital services and free-standing ambulatory surgi-center services provided in connection with a dental service are covered when: • the use of the hospital or free-standing ambulatory surgi-center is medically necessary; and • the setting in which the service received is determined to be appropriate. Preauthorization is recommended for this service.
