Hospital
Services And Supplies – 90%
Inpatient
Hospital
Benefits are
provided for a semiprivate room and hospital services and supplies to
treat an illness or injury. Intensive and coronary care units are also covered
when medically necessary.
All
inpatient hospital admissions must be precertified (non-Medicare individuals
only). Covered hospital
services and supplies include:
- Operating
rooms and equipment.
- Nursing
services (other than the services of a private-duty nurse or
attendant).
- Diagnostic
or therapeutic items or services that are ordinarily furnished by the hospital
for the care and treatment of the patient.
- Anesthesia
including administration and materials.
- Drugs,
biologicals, supplies, appliances, and equipment for use in the hospital that
are ordinarily furnished by the hospital for the care and treatment of the
patient.
Benefits
are
not
provided for a bed or room set aside for a patient while the patient is in a
special care unit.
Outpatient
Hospital
Benefits are
provided for:
- Services
and supplies otherwise provided on an inpatient hospital basis.
- Facility
fees for outpatient surgery, a same-day surgical center or an ambulatory
surgical center.
- Treatment
including x-ray, radium therapy and other radioactive substances, chemotherapy,
and laboratory and diagnostic radiology and imaging.
- Care
in a hospital emergency room. There is a $50 copayment for each visit to the
emergency room. The $50 copayment is waived if the individual is admitted as an
inpatient directly following treatment in the emergency
room.
Benefits
are
not
provided for facility fees for a hospital, ambulatory surgical center or other
surgical facility for surgical services commonly and primarily performed in a
clinic or in a physician’s office.
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