Outside of California. The lower of: (a) the provider’s billed charge, or, (b) the amount, if any, established by the laws of the state to be paid for Emergency Services. Reconstructive Surgery — surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function; or (2) to create a normal appearance to the extent possible; dental and orthodontic services that are an integral part of surgery for cleft palate procedures. Rehabilitation — inpatient or outpatient care furnished to an individual disabled by injury or illness, including Severe Mental Illnesses and Severe Emotional Disturbances of a Child, in order to restore an individual’s ability to function to the maximum extent practical. Rehabilitation services may consist of Physical Therapy, Occupational Therapy, and/or Respiratory Therapy. Benefits for Speech Therapy are described in the section on Speech Therapy Benefits. Resident of California - an individual who spends in the aggregate more than 180 days each year within the State of California and has not established a permanent residence in another state or country. Residential Care — Mental Health or Substance Abuse Services provided in a facility or a free- standing residential treatment center that provides overnight/extended-stay services for Members who do not require acute inpatient care. Respiratory Therapy — treatment, under the direction of a Doctor of Medicine and provided by a certified respiratory therapist, to preserve or improve a patient’s pulmonary function. Routine Outpatient Mental Health and Substance Abuse Services – professional office visits for the diagnosis and treatment of Mental Health and Substance Abuse Conditions including the individual, family, or group setting. Serious Emotional Disturbances of a Child — refers to individuals who are minors under the age of 18 years who:
Outside of California. The Blue Shield Trio HMO provides coverage for you and your family for your Urgent Service needs when you or your family are temporarily traveling outside of California. Urgent Services may be ob- tained from any provider; however, using the BlueCard® or Blue Shield Global Core programs can be more cost-effective and may eliminate the need for you to pay for the services when they are rendered and submit a claim for reimbursement. See the Inter-Plan Arrangements section of this EOC for more information on the BlueCard® and Blue Shield Global Core programs. Out-of-Area Follow-up Care is also covered and services may be received through the BlueCard® or Blue Shield Global Core programs. Authoriza- tion by Blue Shield is required for more than two Out-of-Area Follow-up Care outpatient visits. Blue Shield may direct the patient to receive the additional follow-up services from their Primary Care Physician.
Outside of California. The lower of: (a) the provider’s billed charge, or, (b) the amount, if any, established by the laws of the state to be paid for Emergency Services. Reconstructive Surgery — surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function; or (2) to create a normal appearance to the extent possible, including dental and orthodontic services that are an integral part of surgery for cleft palate proce- dures. Rehabilitative Services — Inpatient or outpatient care furnished to an individual disabled by injury or illness, including Severe Mental Illness and Severe Emotional Disturbances of a Child, to restore an individual’s ability to function to the maximum extent practical. Rehabilitative Services may consist of Physical Therapy, Occupational Therapy, and/or Respiratory Therapy. Residential Care — Mental Health or Substance Use Disorder Services provided in a facility or a free-standing residential treatment center that pro- vides overnight/extended-stay services for Mem- bers who do not require acute inpatient care. Respiratory Therapy — treatment, under the di- rection of a Physician and provided by a certified respiratory therapist, or other appropriately li- censed or certified Health Care Provider to pre- serve or improve a patient’s pulmonary function. Serious Emotional Disturbances of a Child —a minor under the age of 18 years who:
Outside of California. The lower of: (a) the provider’s billed charge, or, (b) the amount, if any, established by the laws of the state to be paid for Emergency Services. Reconstructive Surgery — surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function; or (2) to create a normal appearance to the extent possible; dental and orthodontic services that are an integral part of surgery for cleft palate procedures. Rehabilitation — inpatient or outpatient care furnished to an individual disabled by injury or illness, including Severe Mental Illness and Severe Emotional Disturbances of a Child, in order to restore an individual’s ability to function to the maximum extent practical. Rehabilitation services may consist of Physical Therapy, Occupational Therapy, and/or Respiratory Therapy. Resident of California - an individual who spends in the aggregate more than 180 days each year within the State of California and has not established a permanent residence in another state or country. Residential Care — Mental Health or Substance Abuse Services provided in a facility or a free-standing residential treatment center that provides overnight/extended-stay services for Members who do not require acute inpatient care. Respiratory Therapy — treatment, under the direction of a Doctor of Medicine and provided by a certified respiratory therapist, or other appropriately licensed or certified Health Care Provider to preserve or improve a patient’s pulmonary function.
Outside of California. The Blue Shield Access+ HMO provides coverage for you and your family for your Urgent Service needs when you or your family are temporarily traveling outside of California. Urgent Services may be obtained from any provider; however, us- ing the BlueCard® or Blue Shield Global Core pro- grams can be more cost-effective and may elimi- additional follow-up services from their Primary Care Physician.
Outside of California. The lower of: (a) the provider’s billed charge, or (b) the amount, if any, established by the laws of the state to be paid for Emergency Services. Reconstructive Surgery — surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function; or (2) to create a normal appearance to the extent possible; dental and orthodontic services that are an integral part of surgery for cleft palate procedures. Rehabilitation — inpatient or outpatient care fur- nished to an individual disabled by injury or ill- ness, including Severe Mental Illnesses and Severe Emotional Disturbances of a Child, in order to re- store an individual’s ability to function to the max- imum extent practical. Rehabilitation services may consist of Physical Therapy, Occupational Ther- apy, and/or Respiratory Therapy. Residential Care— Mental Health or Substance Abuse Services provided in a facility or a free- standing residential treatment center that provides overnight/extended-stay services for Members who do not require acute inpatient care. Respiratory Therapy — treatment, under the di- rection of a Doctor of Medicine and provided by a certified respiratory therapist, or other appropri- ately licensed or certified Health Care Provider to preserve or improve a patient’s pulmonary func- tion. Routine Outpatient Mental Health and Substance Abuse Services – professional office visits for the diagnosis and treatment of Mental Health and Substance Abuse Conditions, including the individual, family or group setting. Serious Emotional Disturbances of a Child — refers to individuals who are minors under the age of 18 years who:
Outside of California. The lower of: (a) the provider’s billed charge, or (b) the amount, if any, established by the laws of the state to be paid for Emergency Services. Reconstructive Surgery — surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (1) to improve function; or (2) to create a normal appearance to the extent possible; dental and orthodontic services that are an integral part of surgery for cleft palate procedures. Rehabilitation — inpatient or outpatient care fur- nished to an individual disabled by injury or ill- ness, including Severe Mental Illnesses and Severe Emotional Disturbances of a Child, in order to re- store an individual’s ability to function to the max- imum extent practical. Rehabilitation services may consist of Physical Therapy, Occupational Ther- apy, and/or Respiratory Therapy. Residential Care— Mental Health or Substance Use Disorder Services provided in a facility or a free-standing residential treatment center that pro- vides overnight/extended-stay services for Mem- bers who do not require acute inpatient care. Respiratory Therapy — treatment, under the di- rection of a Doctor of Medicine and provided by a certified respiratory therapist, or other appropri- ately licensed or certified Health Care Provider to preserve or improve a patient’s pulmonary func- tion. Serious Emotional Disturbances of a Child — refers to individuals who are minors under the age of 18 years who:
Outside of California. The Blue Shield Access+ HMO provides cover- age for you and your family for your Urgent Ser- vice needs when you or your family are temporar- ily traveling outside of California. You can re- ceive urgent care services from any provider; however, using the BlueCard® Program, de- scribed herein, can be more cost-effective and eliminate the need for you to pay for the services when they are rendered and submit a claim for reimbursement. Note: Authorization by Blue Shield is required for care that involves a surgical or other procedure or inpatient stay. Out-of-Area Follow-up Care is covered and ser- vices may be received through the BlueCard Pro- gram participating provider network or from any provider. However, authorization by Blue Shield is required for more than two Out-of-Area Fol- low-up Care outpatient visits. Blue Shield may direct the patient to receive the additional follow- up services from the Personal Physician.
Outside of California. The Blue Shield Access+ HMO provides coverage for you and your family for your Urgent Service needs when you and your family are temporarily traveling outside of California. You can receive urgent care services from any provider; however, using the BlueCard® Program, described herein, can be more cost-effective and eliminate the need for you to pay for the services when they are rendered and submit a claim for reimbursement. Note: Authorization by Blue Shield is required for care that involves a surgical or other procedure or inpatient stay. Out of Area Follow-up Care is covered and services may be received through the BlueCard® Program participating provider network or from any provider.
