Wellcare CalViva Health Dual Align (HMO D-SNP): Outpatient Surgery

Many surgeries today are performed in ambulatory surgical centers or outpatient hospital facilities and do not require a hospital stay.

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Cost
$0 copay for each Medicare-covered visit
Prior Authorization Required
Yes, except in an emergency
Provider Referral or Order Required
Yes

How To Receive

Details on how to apply

  • $0 copay for each Medicare-covered visit to an outpatient hospital facility, including Medicare-covered diagnostic colonoscopy.

  • $0 copay for each Medicare-covered visit to an ambulatory surgical center, including Medicare-covered diagnostic colonoscopy.


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Availability
Ongoing, as ordered and authorized

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Outpatient surgery is also referred to as "same-day" surgery and "ambulatory" surgery.

Many surgeries today can be performed on an outpatient basis and do not require admission to the hospital. Examples include but are not limited to, knee and hip arthroplasty/replacement, removal of non-malignant growths, cataract surgery, and laparoscopies.

When having surgery in a hospital facility, however, check with the provider about the expected inpatient or outpatient status following the surgery. Unless the provider writes an order for inpatient admission to the hospital, the status will be outpatient, and payment of cost-sharing amounts for outpatient surgery is required. Even with an overnight hospital stay, it may still be considered outpatient.

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