Skilled Nursing Facility Care. This benefit has one or more exclusions as specified in the Exclusions Section. Room and board and other necessary services furnished by a Skilled Nursing Facility are Covered and require Prior Authorization. Admission must be appropriate for your Medically Necessary care and rehabilitation. Refer to your Summary of Benefits and Coverage for your visit limitations. Smoking Cessation Counseling/Program This benefit has one or more exclusions as specified in the Exclusions Section. Coverage is provided for Diagnostic Services, Smoking Cessation Counseling and pharmacotherapy. Medical services are provided by licensed Health Care Professionals with specific training in managing your Smoking Cessation Program. The program is described as follows: • Individual counseling at a Practitioner’s/Provider’s office is Covered under the medical benefit. The non-specialist Copayment applies. • Group counseling, including classes or a telephone Quit Line, are Covered through an In- network Practitioner/Provider. No Cost Sharing will apply and there are no dollar limits or visit maximums. Reimbursements are based on contracted rates. • Some organizations, such as the American Cancer Society and Tobacco Use Prevention and Control (XXXXX), offer group counseling services at no charge. You may want to utilize these services. For more information contact our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. Pharmacotherapy benefit Limitations • Prescription Drugs/Medications purchased at a Pharmacy • Two 90-day courses of treatment per Contract Year Refer to your Summary of Benefits and Coverage and your Formulary for your Cost Sharing amount. Special Inpatient Services Special inpatient services (including but not limited to private room and board and/or special duty nursing requires Prior Authorization. Telemedicine Services PIC provides coverage for telemedicine services to the same extent that this agreement covers the same services when provided in-person. PIC will not impose originating-site restrictions. Coverage maybe extended to out-of-network providers in instances where no in-network provider is accessible, as defined by network adequacy standards.
Skilled Nursing Facility Care. This benefit has one or more exclusions as specified in the Exclusions Section. Room and board and other necessary services furnished by a Skilled Nursing Facility are Covered and require Prior Authorization. Admission must be appropriate for your Medically Necessary care and rehabilitation. Refer to your Summary of Benefits and Coverage for your visit limitations.
Skilled Nursing Facility Care. Care that is most appropriately provided in a Skilled Nursing Facility, but at MVP’s discretion is provided on an inpatient basis in a Hospital, may be covered under your Skilled Nursing Facility benefits.
