Outpatient Care. Include costs associated with a subject while not occupying a bed. It normally includes ancillary costs only.
Outpatient Care. We cover the following outpatient care: • Primary care visits for internal medicine, family practice, pediatrics, and routine preventive obstetrics/gynecology Services (refer to “Preventive Health Care Services” for coverage of preventive care Services); • Specialty care visits (refer to “Referrals to Plan Providers” in the “How to Obtain Services” section for information about referrals to Plan specialists); • Consultations and immunizations for foreign travel; • Diagnostic testing for care or treatment of an illness; or to screen for a disease for which you have been determined to be at high risk for contracting. This includes, but is not limited to: • Diagnostic exams, including digital rectal exams and prostate antigen (PSA) tests provided: • to persons age 40 and over; who are at high risk for prostate cancer according to the most recent published guidelines of the American Cancer Society; • Colorectal cancer screening, specifically: screening with an annual fecal occult blood test; flexible sigmoidoscopy or colonoscopy; or, when appropriate, radiologic imaging, for persons, who are at high risk of cancer. High risk is determined based on the most recently published guidelines of the American College of Gastroenterology, in consultation with the American Cancer Society; • Bone mass measurement for the prevention, diagnosis, and treatment of osteoporosis for a qualified individual when a Plan Provider requires the bone mass measurement. A “qualified individual” means: • an estrogen deficient person at clinical risk for osteoporosis; • a person with a specific sign suggestive of spinal osteoporosis. This includes: roentgeno-graphic osteopenia or roentgenographic evidence suggestive of collapse; wedging; or ballooning of one or more thoracic or lumbar vertebral bodies; and who is a candidate for therapeutic intervention or for an extensive diagnostic evaluation for metabolic bone disease; • a person receiving long-term gluco- corticoid (steroid) therapy; • a person with primary hyper- parathyroidsm; or • a person being monitored to assess the response to or efficacy of an approved osteoporosis drug therapy; (Refer to “Preventive Health Services” for coverage of preventive care tests and screening Services); • Outpatient surgery; • Anesthesia; including Services of an anesthesiologist; • Chemotherapy and radiation therapy; • Respiratory therapy; • Medical social Services; • House calls when care can best be provided in your home as determined by a Plan Pr...
Outpatient Care. The applicable Vectrus Welfare Plan shall be liable for the portion of ongoing outpatient care that is provided before the Welfare Plan Implementation Date, and the applicable Exelis Welfare Plan shall be responsible for the portion of ongoing outpatient care that is provided after the Welfare Plan Implementation Date.
Outpatient Care. 6 - Doctor Office Visits Member pays 20% of Medicare- approved amounts after Medicare Part B Deductible is satisfied. Member pays: − The lesser of the Group Cost Share or $15 for each primary care doctor office visit for Medicare-covered services. − The lesser of the Group Cost Share or $100 for each Medicare-covered ambulatory surgical center. − The lesser of the Group Cost Share or $100 for each Medicare-covered outpatient hospital services visit. − Member pays the lesser of the Group Cost Share or $15 for each Medicare-covered consultation and certain specialist visits.
Outpatient Care. We cover the following outpatient care for preventive medicine, diagnosis and treatment:
Outpatient Care. 8 - Doctor Office Visits 20% coinsurance General See “Physical Exams” for more information. Authorization rules may apply. In-Network You pay the lesser of the Group cost share or $20 copay for each primary care doctor office visit for Medicare- covered services. You pay the lesser of the Group cost share or $20 copay for each specialist visit for Medicare-covered services.
Outpatient Care. An outpatient is defined as a patient who receives medical services and is not admitted as an inpatient by the treating physician. Outpatient treatment commences the day of the first appointment with a treating medical practitioner. The last outpatient day is the day of the last appointment for the same episode of care.
Outpatient Care. Care provided to a Youth in a medical clinic or hospital, which requires observation and/or treatment of the patient for 23 hours or less.
Outpatient Care. Benefits are available for the following outpatient services rendered in the outpatient department of a hospital or in an ambulatory surgical facility, or other facility in connection with a medical or surgical procedure covered under the Outpatient and Office Services Section of this Description of Covered Services.
Outpatient Care. D. SURGERY ...................................................................................................................
