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Coverage of Office Visits & Emergency Dept. Part of the Medical Plan 11.

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Presentation on theme: "Coverage of Office Visits & Emergency Dept. Part of the Medical Plan 11."— Presentation transcript:

1 Coverage of Office Visits & Emergency Dept. Part of the Medical Plan 11

2 What will this presentation cover? Well visits (annual physicals) Sick visits Specialists visits Substance abuse/mental health Emergency Department visits 2

3 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

4 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

5 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

6 Substance abuse & mental health outpatient visits $20.00 co-pay Call United Behavioral Health at for optimal benefits 6

7 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 7

8 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. $ co-pay for ED visits 8


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