Coverage of Office Visits &

Emergency Dept.Part of the Medical Plan

11

What will this presentation

cover?Well visits (annual physicals)

Sick visits

Specialists visits

Substance abuse/mental health

Emergency Department visits

2

Well visits

Well visits have $0 co-pay (free of charge!)

The determinant of whether an office visit is a well visit is whether it is recorded as a “v – code”. The doctor’s office can tell you if part or all of your visit will use “v - codes”

3

Well visits (continued)

Well visits include Office visit Well baby visits Routine, non-diagnostic lab charges Colonoscopy Mammogram Prostate exam Paps

NOTE: These items would need to be recorded as “v – codes”, routine NOT diagnostic

4

Sick visits such as ear infections, sore throats, accidents/injuries, etc

No PCP or referral needed

$20.00 co-pay if within CMH PHO and United Healthcare Options PPO

Cost goes to your deductible and co-insurance if outside the CMH PHO and United Healthcare Options PPO

5

Substance abuse & mental health outpatient visits

$20.00 co-pay

Call United Behavioral Health at 1-866-868-7406 for optimal benefits

6

Specialist visitsNo referral needed

$40.00 co-pay if in CMH PHO or United Healthcare Options PPO

Cost goes to your deductible and co-insurance if outside the CMH PHO and United Healthcare Options PPO

7

Emergency Department visits

Charges in the ED generate significantly higher costs and those in physician offices. Therefore the ED visits have higher co-pays than office visits or even specialist visits.

$100.00 co-pay for ED visits

8