Agenda - 10-02-1995 - IX-C - Laserfiche WebLink

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12 ADDITIONAL INFORMATION ABOUT PREFERRED CARE SELECT FROM BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA Provider's Reasonable Charge (PRC). The charge that Blue Cross and Blue Shield of North Carolina determines is reasonable for covered services provided to a member. Special Services/Providers Deductible. Special services and services of special providers are amount each calendar year All covered services under subject to the$200 preferred benefits calendar year this option apply toward meeting the calendar year deductible. You will pay only one maximum deductible deductible. Admission Certification. Many medical and surgical procedures that were hospital admissions must be certified prior to the previously performed on an inpatient basis can now be hospitalization.Approval for emergency and maternity done safely in a less costly outpatient setting.Admission admissions should be requested within two days or on certification is a program designed to make sure that the first business day after the admission. your care is given in a cost effective setting and an If the admission is not certified,charges for room and efficient manner board will not be covered by Blue Cross and Blue Shield If you need to be hospitalized, you must obtain of North Carolina. admission certification.'Nonemergency and nonmaternity Length of Stay Assignment. When Preferred Care Select subscribers are admitted help avoid unnecessary and costly hospital days to keep to a nonpreferred hospital, the doctor must obtain a costs to a minimum. If a longer stay is needed, the length of stay assignment as well as admission certification. doctor should contact Blue Cross and Blue Shield of With a length of stay assignment,a certain number of North Carolina. days will be approved for the hospital stay.The length of If a Preferred Care Select subscriber is admitted to a stay assignment reflects the number of inpatient days that nonpreferred hospital and does not obtain a length of are normally necessary to treat the patient's condition. stay assignment, room and board charges will not be The length of stay assignment program is designed to covered by Blue Cross and Blue Shield of North Carolina. Emergency Care. During an emergency, the initial visit or admission will preferred hospital.The preferred level of benefits includes be paid at the preferred level of benefits even when the$200 preferred deductible(with a maximum of$600 services are not provided by a preferred doctor or in a per family)and the preferred copayment of 10 percent. Chemical Dependency. All chemical dependency benefits are subject to the lifetime and calendar year chemical dependency maximums. Preferred Care Providers. A directory of doctors who participate in our Preferred Care Select program, the preferred hospitals and the preferred ambulatory surgical facilities will be included in your employee information. Facility Providers. Private duty nursing is covered for agencies only; it is not covered for individual facilities. Carry Over Credit. Expenses incurred for covered services in the last that calendar year deductible will be applied to the three months of a calendar year which were applied to deductible of the next calendar year. This fact sheet is a summary of Preferred Care Select limitations and exclusions of Preferred Care Select are benefits Plan S3.This is meant only to be a summary. found in and governed by the group contract. Final interpretation and a complete listing of benefits, L901 5,95 0�