Wellcare Dual Align (HMO D-SNP): 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.
How To Receive
Details on how to apply
The plan covers medically-necessary services that you get in the outpatient department of a hospital for diagnosis or treatment of an illness or injury.
Covered services include, but are not limited to:
Services in an emergency department or outpatient clinic, such as observation services or outpatient surgery
Laboratory and diagnostic tests billed by the hospital
Mental health care, including care in a partial-hospitalization program, if a doctor 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 you can’t give yourself
Note: Unless the provider has written an order to admit you as an inpatient to the hospital, you are an outpatient and pay the cost sharing amounts for outpatient hospital services. Even if you stay in the hospital overnight, you might still be considered an outpatient. If you are not sure if you are an outpatient, you should ask the hospital staff.
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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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