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
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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.
About us
Helpful is an app to make caregiving easier. We integrate your loved one’s insurance benefits, medical records and caregiving guides into an immediate, accessible and user-friendly experience. Helpful supports your care needs by eliminating administrative tasks and providing technology to support your caregiving experience.
