Wellcare CalViva Health Dual Align (HMO D-SNP): 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.
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If you have exhausted your inpatient benefits or if the inpatient stay is not reasonable and necessary, we will not cover your inpatient stay. However, in some cases, we will cover certain services you receive while you are in the hospital or the skilled nursing facility (SNF).
Contact the Member Services at 1-800-431-9007. (TTY users should call 711) to determine if inpatient benefits have been exhausted or if inpatient stay is not reasonable and necessary.
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 a change in the patient’s physical condition
Physical therapy, speech therapy, and occupational therapy
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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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