Outpatient Services. The following services are covered only at the Primary Care Provider’s office[selected by a [Member], or elsewhere [upon prior written Referral by a [Member]'s Primary Care Provider ]:
Outpatient Services. Physicians, Urgent Care Centers and other Outpatient Providers located outside the BlueCard® service area will typically require You to pay in full at the time of service. You must submit a Claim to obtain reimbursement for Covered Services.
Outpatient Services. Medical treatments or services provided or ordered by a physician for the Insured when the Insured is not admitted at a Hospital. Outpatient services may include services performed in a hospital or emergency room.
Outpatient Services. After Deductible, Member pays 20% Plan Coinsurance Injections administered by a Network Provider in a clinical setting during dialysis. Outpatient Services: After Deductible, Member pays 20% Plan Coinsurance Self-administered injectables. See Drugs – Outpatient Prescription for additional pharmacy information. Preferred generic drugs (Tier 1): After Deductible, Member pays $15 Copayment per 30-days up to a 90-day supply Preferred brand name drugs (Tier 2): After Deductible, Member pays $30 Copayment per 30- days up to a 90-day supply Non-Preferred generic and brand name drugs (Tier 3): Not covered; Member pays 100% of all charges Drugs - Outpatient Prescription Prescription drugs, supplies and devices for a supply of 30 days or less including diabetic pharmacy supplies (insulin, lancets, lancet devices, needles, insulin syringes, insulin pens, pen needles and blood glucose test strips), mental health and wellness drugs, self-administered injectables, medications for the treatment arising from sexual assault, and routine costs for prescription medications provided in a clinical trial. “Routine costs” means items and services delivered to the Member that are consistent with and typically covered by the plan or coverage for a Member who is not enrolled in a clinical trial. All drugs, supplies and devices must be for Covered Services. All drugs, supplies and devices must be obtained at a KFHPWA-designated pharmacy except for drugs dispensed for Emergency services or for Emergency services obtained outside of the KFHPWA Service Area including out of the country. Information regarding KFHPWA-designated pharmacies is reflected in the KFHPWA Provider Directory or can be obtained by contacting Xxxxxx Permanente Member Services. Prescription drug Cost Shares are payable at the time of delivery. Certain brand name insulin drugs are covered at the generic drug Cost Share. Preferred generic drugs (Tier 1): After Deductible, Member pays $15 Copayment per 30-days up to a 90-day supply Preferred brand name drugs (Tier 2): After Deductible, Member pays $30 Copayment per 30- days up to a 90-day supply Non-Preferred generic and brand name drugs (Tier 3): Not covered; Member pays 100% of all charges Annual Deductible does not apply to glucose monitors, test strips, lancets or control solutions. Note: A Member will not pay more than $100, not subject to the Deductible, for a 30-day supply of insulin to comply with state law requirements. Any cost sharing paid will apply toward...
Outpatient Services. Outpatient services are defined as those preventive, diagnostic, therapeutic, rehabilitative, surgical, mental health, facility services for dental, and Emergency Services received by a patient through an outpatient/ambulatory care facility for the treatment of a disease or injury for a period of time generally not exceeding twenty- four (24) hours. Outpatient or ambulatory care facilities include: (a) Hospital Outpatient Departments, (b) Diagnostic/Treatment Centers, (c) Ambulatory Surgical Centers, (d) Emergency Rooms (ERs), (e) End Stage Renal Disease (ESRD) Clinics and (f) Outpatient Pediatric AIDS Clinics (OPAC). The CONTRACTOR shall:
Outpatient Services. The Plan provides Benefits for the following Hospital Outpatient, Federally Qualified Health Center and Rural Health Clinic services:
Outpatient Services. Benefits for outpatient mental health care services include the outpatient treatment of mental illness by a hospital, a physician or another eligible provider. Attention deficit/hyperactivity disorder (ADHD) is classified as a mental health condition. Treatments for ADHD are eligible under mental health care benefits including medication checks by a Provider other than the Member’s PCP. However, medication checks provided by a Member’s PCP are considered medical visits.
Outpatient Services. Outpatient services including but not limited to: assessment, stabilization, treatment planning, discharge planning, verbal therapies, education, symptom management, case management services, crisis intervention and outreach services, chlozapine monitoring and collateral services as certified by OMH. Services may be provided in-home, office or the community. Services may be provided by licensed OMH providers or by other providers of mental health services including clinical psychologists and physicians. For further information regarding service coverage consult the following MMIS Provider Manuals: Clinic, Ambulatory Services for Mental Illness (Clinic Treatment Program), Clinical Psychology, and Physician (Psychiatric Services). Enrollees must be allowed to self-refer for one (1) mental health assessment from a Contractor's Participating Provider in a twelve (12) month period. In the case of children, such self-referrals may originate at the request of a school guidance counselor or similar source. Services provided through OMH designated clinics for Enrollees with a clinical diagnosis of SED are covered by Medicaid fee-for-service. APPENDIX K October 1, 2004 K-25
Outpatient Services a. Ancillary Services Hospital services and supplies including, but not restricted to:
Outpatient Services. Outpatient mental health services place priority on restoring the Member to his/her level of functioning prior to the onset of acute symptoms or to achieve a clinically appropriate level of stability as determined by GHC’s Medical Director, or his/her designee. Treatment for clinical conditions may utilize psychiatric, psychological and/or psychotherapy services to achieve these objectives. Coverage for each Member is provided according to the outpatient mental health care Allowance set forth in the Allowances Schedule. Psychiatric medical services, including medical management and prescriptions, are covered as set forth in Sections IV.B. and IV.J.
