AZ Blue Best Life Plus (HMO): Outpatient Hospital Services
Many services and procedures today are provided as outpatient in ambulatory service areas of the hospital or at freestanding health services centers.
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How To Receive
Details on how to apply
Obtain an in-network provider order for outpatient services (unless visiting the emergency department).
Contact the AZ Blue Best Life Plus Team at 1-800-446-8331 (TTY 711) for prior authorization.
The ordering provider may help with authorization.
Schedule the services at an in-network facility selected by the provider.
It is likely that the scheduling department of that facility will reach out to schedule the services.
The scheduling facility may also help with authorization.
Search in-network hospitals and select one with the appropriate outpatient services.
Attend the appointment and complete the services.
Engage in recommended follow-up treatment and/or referrals.
Copayments and coinsurance
$125 copayment for services in the emergency department. Cost-share is waived if you are admitted to the hospital within one day for the same condition (see Emergency Care benefit for more information).
$200 copayment per visit for outpatient surgery or a procedure. For costs associated with laboratory, diagnostic tests, X-rays, and other radiological services billed by the hospital, refer to the Outpatient Diagnostic Tests and Therapeutic Services and Supplies benefit.
20% coinsurance for supplies.
$25 copayment per individual or group visit for outpatient mental health care.
20% coinsurance per visit for IV therapy or transfusion services (a separate cost-sharing will be assessed for drugs).
20% coinsurance per visit for chemotherapy infusion (a separate cost-sharing will be assessed for drugs).
20% coinsurance for drugs and biologicals that you can’t give yourself.
$25 copayment per visit for hyperbaric oxygen treatment.
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Medically necessary services in the outpatient department of a hospital for diagnosis or treatment of an illness or injury are covered.
Covered services include, but are not limited to
Services in an emergency department or outpatient clinic, such as observation services or ambulatory/outpatient surgery center
Laboratory and diagnostic tests billed by the hospital
Mental health care, including care in a partial-hospitalization program (PHP), if a provider certifies that inpatient treatment would be required without it
X-rays and other radiology services billed by the hospital
Medical supplies such as splints and casts
Certain drugs and biologicals that cannot be self-administered
Unless the provider has written an order for inpatient admission to the hospital, the episode is considered outpatient and cost-sharing amounts for outpatient hospital services apply. Even if there is an overnight hospital stay (rare), it may still be considered outpatient. If outpatient versus inpatient status isn’t clear, ask the hospital staff.
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