AZ Blue Best Life Classic (HMO): Inpatient Stay: Covered Services Received in a Hospital or SNF during a Non-Covered Inpatient Stay

1. Obtain a physician order for inpatient admission to the hospital or skilled nursing facility (SNF).

2. Contact the AZ Blue Best Life Classic Team at 1-800-446-8331 (TTY 711) to determine if inpatient benefits have been exhausted or if inpatient stay is not reasonable and necessary.

   • The admitting provider or the facility may also help with this determination when calling for prior authorization.

3. Work with the inpatient care team on treatment during stay and discharge planning.

4. Continue to work with the AZ Blue Best Life Classic Team on covered services following facility discharge.

Copayment and coinsurance

• $0 copayment per visit for Primary Care Provider (PCP) services.

• $20 copayment for Specialist services.

• $20 copayment per visit for physical, occupational, or speech therapy.

• 20% coinsurance for drugs administered as part of your plan of care.

• $0 copayment for blood (first 3 pints).

• 20% coinsurance for medical and surgical supplies.

• $0 copayment for laboratory tests, except genetic testing, which has a 20% coinsurance.

• $20 copayment for X-rays and other radiological services ordinarily provided by SNFs.

• $25 copayment for carotid and peripheral vascular ultrasounds.

• 20% coinsurance for use of appliances (durable medical equipment and related supplies).

• The cost-sharing described in Outpatient Diagnostic Tests and Therapeutic Services and Supplies benefit will apply to advanced radiology services performed outside the SNF.