![]() Outpatient group therapy visit with a psychiatrist: $25 copay (authorization required).$0 per day for days 6 through 90 (authorization required) Inpatient hospital - psychiatric: $175 per day for days 1 through 5.Physical therapy and speech and language therapy visit: $20 copay (authorization required).Occupational therapy visit: $20 copay (authorization required).$188 per day for days 21 through 100 (authorization required) $25-175 copay per visit (authorization required).$0 per day for days 91 and beyond (authorization required) Urgent care: $0-25 copay per visit (always covered).Emergency: $90 copay per visit (always covered).Outpatient x-rays: $0-25 copay (authorization required).Diagnostic radiology services (e.g., MRI): $25-250 copay (authorization required).Lab services: $0-25 copay (authorization required). ![]() Diagnostic tests and procedures: $0-100 copay (authorization required).Specialist: $25 copay per visit (authorization required)ĭiagnostic procedures/lab services/imaging.Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)Īdditional benefits and/or reduced cost-sharing for enrollees with certain health conditions? Drug plan deductible: No annual deductible.Other health plan deductibles: In-network: No.You must continue to pay your Part B premium.Total Monthly Premium with LIS (Parts C & D): Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ The Monthly Premium is Split as Follows: ❔ This plan qualifies for the 5-star rating Special Enrollment period. Number of Members enrolled in this plan in (H4461 - 031): Number of Members enrolled in this plan in Tennessee: Number of Members enrolled in this plan in Scott, Tennessee: This plan offers select insulin at a $35 copay. See cost-sharing for all pharmacies and tiers. No additional gap coverage, only the Donut Hole Discountīrowse the Humana Gold Plus H4461-031 (HMO) Formulary Maximum Out-of-Pocket Limit for Parts A & B (MOOP): ET.Įmail a copy of the Humana Gold Plus H4461-031 (HMO) benefit details Find a 2022 Medicare Advantage Plan by Drug CostsĬompare and enroll in your Medicare plan with help from licensed agents.Ĭall 83/ TTY: 711, Mon‐Fri 9 a.m.-8 p.m.2022 Medicare Advantage Plan Benefit Details.2022 Medicare Advantage Plans State Overview.IRMAA: Higher premiums for higher incomes.Understanding Your Explanation of Benefits.Medicare plan quality and CMS Star Ratings.Q1Rx Drug-Finder: Compare Drug Cost Across all 2022 Medicare Plans.Browse Any 2022 Medicare Plan Formulary (or Drug List).Find a 2022 Medicare Advantage Plan (Health and Health w/Rx Plans).The law does not prohibit providers/practitioners from billing with the SSN. Social Security numbers may be used for internal verification or administrative purposes, as long as the use does not result in the public display or disclosure of the number in violation of requirements. Utilization Management Medical TeamĪssociate Medical Directors: Allyson Kreshak, MD, Elizabeth Rosenblum, MD Confidentiality Utilization management criteria are available to the member, practitioner and public. All decisions are communicated to the requesting provider via EPIC, and member notification of decisions are sent via.We sometimes use the expertise of our medical specialists to assist in making determinations. The utilization management department consists of administrative data entry coordinators with extensive coding and clinic experience, registered nurses, and a board-certified medical director who oversees all medical decision-making.UC San Diego Health does not sub-delegate any decision making to any other entity.Financial incentives do not encourage decisions that result in under-utilization.We do not reward practitioners or others for issuing denials of coverage or service care.This process is based only on appropriateness of care and service and existence of coverage. Our utlization management department reviews requests for medical necessity and adherence with contractual agreements.The Managed Care team applies these policies when making decisions about insurance eligibility, authorization, referrals and claims: We serve patients of these HMOs who receive primary care at UC San Diego Health: The UC San Diego Health Managed Care team oversees eligibility, pre-authorization, referrals and claims about HMO coverage and can answer questions such as:
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