Outpatient. If you receive dialysis services in a hospital's outpatient unit or in a dialysis facility, we cover the use of the treatment room, related supplies, solutions, drugs, and the use of the dialysis machine. In Your Home If you receive dialysis services in your home and the services are under the supervision of a hospital or outpatient facility dialysis program, we cover the purchase or rental (whichever is less, but never to exceed our allowance for purchase) of the dialysis machine, related supplies, solutions, drugs, and necessary installation costs. Related Exclusions If you receive dialysis services in your home, this agreement does NOT cover: • installing or modifying of electric power, water and sanitary disposal or charges for these services; • moving expenses for relocating the machine; • installation expenses not necessary to operate the machine; or • training you or members of your family in the operation of the machine. This agreement does NOT cover dialysis services when received in a doctor's office.
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
Outpatient. In a Doctor’s or Therapist's Office We cover medically necessary physical and occupational therapy services. In Your Home
Outpatient. We cover medically necessary physical and occupational therapy services. In Your Home This agreement does NOT cover physical or occupational therapy services received in your home unless received through a home care program. See Section 3.15 - Home Health Care. In a Doctor's/Therapist's Office Physical or occupational therapy services received in a doctor's/therapist's office are covered. See the Summary of Medical Benefits for benefit limits and level of coverage.
Outpatient. A person who gets healthcare services without an overnight stay in a healthcare facility. This word also describes the services you get while you are an outpatient. Plan The benefits, terms, and limitations stated in this contract. Prescription Drug Drugs and medications that by law require a prescription. This includes biologicals used in chemotherapy to treat cancer. It also includes biologicals used to treat people with HIV or AIDS. According to the Federal Food, Drug and Cosmetic Act, as amended, the label on a prescription drug must have the statement on it: “Caution: Federal law prohibits dispensing without a prescription.” Prior Authorization Planned services that must be reviewed for medical necessity and approved before you receive them. Provider A person who is in a provider category regulated under Title 18 or Chapter 70.127 RCW to practice health care- related services consistent with state law. Such persons are considered health care providers only to the extent required by RCW 48.43.045 and only to the extent services are covered by the provisions of this plan. Also included is an employee or agent of such a person, acting in the course of and within the scope of his or her employment. Providers also include certain health care facilities and other providers of health care services and supplies, as specifically indicated in the provider category listing below. Health care facilities that are owned and operated by a political subdivision or instrumentality of the State of Washington and other such facilities are included as required by state and federal law. Covered categories of providers regulated under Title 18 and Chapter 70.127 RCW, will include the following, provided that the services they furnish are consistent with state law and the conditions of coverage described elsewhere in this plan are met. The providers are: Acupuncturists (X.Xx.) (In Washington also called East Asian Medicine Practitioners (E.A.M.P.)) Audiologists Chiropractors (D.C.) Counselors Dental Hygienists (under the supervision of a D.D.S. or D.M.D.) Dentists (D.D.S. or D.M.D.) Denturists Dietitians and Nutritionists (D. or C.D., or C.N.) Home Health Care, Hospice and Home Care Agencies Marriage and Family Therapists Massage Practitioners (L.M.P.) Midwives Naturopathic Physicians (N.D.) Nurses (R.N., L.P.N., A.R.N.P., or N.P.) Nursing Homes Occupational Therapists (O.T.A.) Ocularists Opticians (Dispensing) Optometrists (O.D.) Ost...
Outpatient. We cover medically necessary visits in a cardiac rehabilitation program. See the Summary of Medical Benefits for benefit limits and the amount that you pay, if any.
Outpatient. This is medically necessary diagnosis, treatment, services or supplies provided by a hospital's outpatient department, or a licensed surgical center and other ambulatory facility (other than in any physician's office). Physician. This is a licensed medical doctor, or doctor of osteopathy, lawfully performing a medical service, in accordance with governmental licensing privileges and limitations, who renders medical or surgical care to our members as covered in this Contract.
Outpatient. In a Doctor’s or Therapist's Office We cover medically necessary physical and occupational therapy services. See the Summary of Medical Benefits for benefit limits and the amount you pay. In Your Home This agreement does NOT cover physical or occupational therapy services received in your home unless received through a home care program. See Section 3.14 - Home Health Care.
Outpatient. This refers to services provided to an inmate housed outside of an inpatient mental health unit or admitted to an infirmary for mental health reasons as distinct from a more specialized inpatient unit. Outpatient mental healthcare services include, but are not limited to, individualized service planning, case management, group and/or individual counseling, periodic psychiatric monitoring and/or treatment as determined necessary, confinement mental status evaluations, emergency evaluations and staff referrals.
Outpatient. [Member], if not confined as a registered bed patient in a Hospital or recognized health care Facility and is not an Inpatient; or services and supplies provided in such Outpatient settings. [PARTICIPATING MAIL ORDER PHARMACY. A licensed and registered pharmacy operated by [ABC] or with whom [ABC] has signed a pharmacy service agreement, that is: equipped to provide Prescription Drugs through the mail; or is a Participating Pharmacy that is willing to accept the same pharmacy agreement terms, conditions, price and services as exist in the Participating Mail Order Pharmacy agreement.] [PARTICIPATING PHARMACY. A licensed and registered pharmacy operated by Us or with whom We have signed a pharmacy services agreement.]
