Coverage of Office Visits & Emergency Dept.

Coverage of Office Visits & Emergency Dept. Part of the Medical Plan 1

What will this presentation cover? Well visits (annual physicals) Sick visits Specialists visits Substance abuse/mental health Emergency Department visits

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”

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

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

Substance abuse & mental health outpatient visits $20.00 co-pay Call United Behavioral Health at 1-866-868-7406 for optimal benefits

Specialist visits No 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

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

Coverage of Office Visits & Emergency Dept.