AZ Blue Best Life Plus (HMO): Inpatient Stay: Covered Services Received in a Hospital or SNF during a Non-Covered Inpatient Stay
If inpatient benefits are exhausted or the inpatient stay is not reasonable and necessary, the stay will not be covered - but certain services may.
How To Receive
Details on how to apply
Obtain a physician order for inpatient admission to the hospital or skilled nursing facility (SNF).
Contact the AZ Blue Best Life Plus 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.
Work with the inpatient care team on treatment during stay and discharge planning.
Continue to work with the AZ Blue Best Life Plus Team on covered services following facility discharge.
Copayment and coinsurance
$0 copayment per visit for Primary Care Provider (PCP) services.
$25 copayment for Specialist services.
$10 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.
$10 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.
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If inpatient benefits have been exhausted or if the inpatient stay is not reasonable and necessary, the inpatient stay will not be covered. However, in some cases, the plan will cover certain services received while in the hospital or the skilled nursing facility (SNF). Covered services include, but are not limited to:
Physician services
Diagnostic tests (like lab tests)
X-ray, radium, and isotope therapy including technician materials and services
Surgical dressings
Splints, casts, and other devices used to reduce fractures and dislocations
Prosthetics and orthotics devices (other than dental) that replace all or part of an internal body organ (including contiguous tissue), or all or part of the function of a permanently inoperative or malfunctioning internal body organ, including replacement or repairs of such devices
Leg, arm, back, and neck braces; trusses, and artificial legs, arms, and eyes, including adjustments, repairs, and replacements required because of breakage, wear, loss, or change in the patient's physical condition
Physical therapy, speech therapy, and occupational therapy
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