Wellcare Dual Liberty (HMO D-SNP) (009): 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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Cost
Copayments and coinsurance costs vary by service
Prior Authorization Required
Yes, except in an emergency
Provider Referral or Order Required
Yes

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.

Availability
Ongoing
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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

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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