PLAN OF TREATMENT a plan of care which is developed or approved by a Member’s Primary Care Physician for the treatment of an injury or illness. The Plan of Treatment should be limited in scope and extent to that care which is Medically Necessary for the Member's diagnosis and condition. PREAUTHORIZATION – An authorization (or approval) from Keystone Health Plan Central or its designee which results from a process utilized to determine member eligibility at the time of request, benefit coverage and medical necessity of proposed medical services prior to delivery of services. Preauthorization is required for the procedures identified in the Preauthorization Program attachment to this Agreement. PREMIUM – The payment due for coverage under this Agreement. PROFESSIONAL PROVIDER – a person or practitioner who is certified, registered or who is licensed and performing services within the scope of such licensure. The Professional Providers are: Audiologist Certified Registered Nurse Anesthetist Certified Registered Nurse Midwife Certified Nurse Practitioner Chiropractor Clinical or Physician Laboratory Doctor of Medicine (M.D.) Doctor of Osteopathy (D.O.) Licensed Dietitian-Nutritionist Licensed Social Worker Occupational Therapist Oral Surgeon Physical Therapist Physician Assistant Podiatrist Psychologist Respiratory Therapist Social worker/Other Masters Prepared Therapists Speech Language Pathologist PROVIDER – A hospital, physician, person or practitioner licensed (where required) and performing services within the scope of such licensure and as identified in this Agreement. Providers include participating providers and non-participating providers. QUALIFIED HEALTH PLAN or QHP – Qualified Health Plan or QHP means a health plan that has in effect a certification from the United Stated Secretary of Health and Human Services that it is certified to be offered on the Exchange/Marketplace.
PLAN OF TREATMENT a plan of care which is prescribed in writing by a Professional Provider for the treatment of an injury or illness. The Plan of Treatment should include goals and duration of treatment, and be limited in scope and extent to that care which is Medically Appropriate/Medically Necessary for the Covered Person's diagnosis and condition. PLAN-WIDE DISCOUNT – the percentage reduction from hospital charges for Covered Services that the Carrier passes on to its customers as a share of the savings the Carrier is expected to realize from its negotiated hospital contracts. The amount of the discount may be changed prospectively from time to time. The amount of the discount is on file with the Pennsylvania Insurance Department. PRECERTIFICATION (or PRECERTIFY) – prior assessment by the Carrier or designated agent that proposed services, such as hospitalization, are Medically Appropriate/Medically Necessary for a Covered Person and covered by this Plan. Payment for services depends on whether the Covered Person and the category of service are covered under this Plan.
PLAN OF TREATMENT. The Ancillary Service shall, if appropriate, review the original plan of treatment for each Participant to whom the Ancillary Service provides the Covered Services hereunder with said Participant's attending Physician, and shall submit said Participant's plan of treatment to said Physician for recertification, at such intervals as the severity of said Participant's medical condition requires by at least every thirty (30) calendar days or such shorter period as applicable Federal and State law shall require.
PLAN OF TREATMENT. Therapy is a collaborative process, and we begin by identifying and discussing the problems and concerns that are most important to you. The first 2-4 sessions of our work together will be dedicated largely to identifying your goals for treatment, which will guide your psychotherapy. During these first few sessions, I will evaluate your or your child’s needs, and then share with you my initial understanding of your or your child’s difficulties, whether you/your child can benefit from treatment, the procedures to be used in the course of therapy, and my assessment of the possible outcomes of treatment. These initial weeks are also a time for you to decide if I am the right person for you. You have the right to know about other treatments for your difficulty. You have the right to stop therapy at any time, but I ask that you agree to discuss the possibility of stopping with me beforehand so that we can meet for at least one final session to review our work. If you wish to seek treatment elsewhere, I can provide you with names of other qualified professionals who might be able to assist you. Treatment involves an investment of time, money, and energy, so you should decide carefully if you want to proceed. If you have unanswered questions about the treatment plan, you have the right to ask and receive a complete answer.
