AMBULATORY SURGICAL CENTER. (FREESTANDING) means a state licensed facility, which is equipped to provide surgery services on an outpatient basis.
AMBULATORY SURGICAL CENTER. An Allied Health Facility Provider that is established with an organized medical staff of Physicians. This type of center has permanent facilities that are equipped and operated mainly to perform surgical procedures. A center has continuous Physician and registered professional nursing services available whenever patients are in the facility, does not provide services or other accommodations for patients to stay overnight, and offers the following services whenever patients are in the center: ◼ Anesthesia services as needed for medical operations and procedures performed; ◼ Provisions for patients’ physical and emotional well-being; ◼ Provision for Emergency services; ◼ Organized administrative structure; and ◼ Administrative, statistical, and medical records. Appeal – A request from a Member or a Member’s authorized representative to change a decision We made about Benefits. Bed, Board and General Nursing Service – Room accommodations, meals, and all general services and activities that Hospital employees provide to care for patients. This service includes all nursing care and nursing instructional services provided as a part of the Hospital’s bed-and-board charge.
AMBULATORY SURGICAL CENTER. Services rendered at an Ambulatory Surgical Center include:
AMBULATORY SURGICAL CENTER. The services set forth in Section 3.12.1 of this Certificate are Covered Services when provided in an Ambulatory Surgical Center setting by physician Providers (or other physicians in response to an emergency) or under the orders of a physician.
AMBULATORY SURGICAL CENTER. A Facility currently licensed by the appropriate state regulatory agency for the provision of surgical and related medical services on an outpatient basis. Authorized Service(s): A Covered Service rendered by any Provider other than a Network Provider, which has been authorized in advance (except for Emergency Care which may be authorized after the service is rendered) by Us to be paid at the Network level. The Member may be responsible for any applicable Network Coinsurance, Copayment or Deductible. For more information, see the Claims Payment section. Balance Billing: When a Non-Network Provider bills You for the difference between the Non-Network Provider’s charge and the Allowed Amount. A Network Provider may not Balance Bill You for Covered Services. Benefit Period or Plan Year: The 12 months that We will pay benefits for Covered Services. If Your coverage ends before this length of time, then the Benefit Period also ends. The Benefit Period or Plan Year begins on Your Effective Date, which means it may not correspond with the calendar year. Benefit Period Maximum: The maximum that We will pay for specific Covered Services during a Benefit Period. Brand Name Drug: The first version of a particular medication to be developed or a medication that is sold under a pharmaceutical manufacturer’s own registered trade name or trademark. The original manufacturer is granted a patent, which allows it to be the only company to make and sell the new drug for a certain number of years. Child, Children: The Subscriber’s Children, including any natural, adopted or step- children, unmarried disabled Children, newborn Children, or any other Children as described in the Who is Covered section of this Policy. Coinsurance: A specific percentage of the Maximum Allowable Amount for Covered Services, that is indicated in the Schedule of Benefits, which You must pay. Coinsurance normally applies after the Deductible that You are required to pay. See the Schedule of Benefits for any exceptions. Copayment: A specific dollar amount of the Maximum Allowable Amount for Covered Services, that is indicated in the Schedule of Benefits, which You must pay. The Copayment does not apply to any Deductible that You are required to pay. Your Copayment will be the lesser of the amount shown in the Schedule of Benefits or the amount charged by the Provider. Cost-Sharing: Amounts You must pay for Covered Services, expressed as Copayments, Deductibles and/or Coinsurance. Cost-Sharing Reductio...
AMBULATORY SURGICAL CENTER. A Facility currently licensed by the appropriate state regulatory agency for the provision of surgical and related medical services on an outpatientbasis. Appeal: a Grievance concerning Adverse Determinations, including urgent care, concurrent, pre-service or post-service claims. Authorized Service(s): A Covered Service rendered by any Provider other than a Network Provider, which has been authorized in advance (except for Emergency Care which may be authorized after the service is rendered) by Us to be paid at the Network level, subject to any applicable Network Coinsurance, Copayment or Deductible. For more information, see the Claims Payment section. Balance Billing: When a Non-Network Provider bills You for the difference between the Non-Network Provider’s charge and the Allowed Amount. A Network Provider may not Balance Bill You for Covered Services. Behavioral Health Services: Services or supplies to treat a mental or emotional condition or substance use disorder. Benefit Period: The length of time that We will pay benefits for Covered Services. The Benefit Period is listed in the Schedule of Benefits. If Your coverage ends before this length of time, then the Benefit Period also ends.
