AZ Blue Best Life Classic (HMO): Inpatient Hospital Care

Inpatient care begins upon admission into the hospital as an inpatient (i.e., not as observation, which is still outpatient). Settings include inpatient acute, inpatient rehabilitation, long-term acute care hospitals (LTAC), and other types of inpatient hospital services. Inpatient hospital care starts on the day of formal admission into the hospital with a provider’s order and begins the benefit period (see below). The day before discharge is the last inpatient day. Except in an emergency, the provider must inform the plan of hospital admission. 

Covered services include but are not limited to:

• Semi-private room (or  a private room if medically necessary)

• Meals including special diets

• Regular nursing services

• Costs of special care units (such as intensive care or coronary units)

• Drugs and medications

• Lab tests

• X-rays and other radiology services

• Necessary surgical and medical supplies

• Use of appliances, such as wheelchairs

• Operating and recovery room costs

• Physical, occupational, and speech-language therapy

• Inpatient substance abuse services

• Under certain conditions, some transplants are covered

• Blood - including storage and administration*

• Physician services

To be an inpatient, the provider must write an order for admission as an inpatient of the hospital. Even if there is an overnight stay in the hospital, it might still be considered an outpatient. If inpatient or outpatient status is unclear, ask the hospital staff.

BENEFIT PERIOD: There is no limit to the number of benefit periods. A benefit period starts on the day of admission into a hospital or skilled nursing facility. It ends after 60 days in a row without hospital or skilled nursing care. Upon hospital admission, after one benefit period has ended, a new benefit period begins.

If inpatient care is received at an out-of-network hospital following the stabilization of an emergency condition, the coverages and costs will be the same as a network hospital. Admission to an out-of-network hospital without a preceding emergency, however, will cost more. For admissions without a preceding emergency (such as direct from a provider's office or outpatient facility), the provider should choose a network hospital.

*Coverage of whole blood and packed red cells begins only with the fourth pint of blood needed—costs for the first 3 pints of blood in a calendar year must be paid out-of-pocket or the blood must be donated from self or by someone else. All other components of blood are covered beginning with the first pint.