Multiple Medical or Surgical Services Sample Clauses
The "Multiple Medical or Surgical Services" clause defines how payments or reimbursements are handled when a patient receives more than one medical or surgical service during a single visit or procedure. Typically, this clause outlines that the primary service is reimbursed at the full rate, while additional services performed during the same session may be reimbursed at a reduced rate, reflecting efficiencies gained by performing them together. This approach helps prevent overpayment for bundled services and ensures fair compensation for providers while controlling costs for payers.
Multiple Medical or Surgical Services. When Medically Necessary multiple services (concurrent, successive, or other multiple medical or surgical services) are performed at the same encounter, Benefits will be paid as follows:
a. Primary Service
(1) The primary or major service will be determined by Us.
(2) Benefits for the primary service will be based on the Allowable Charge.