After an illness or injury, you many lose the ability to perform everyday activities such as bathing, preparing meals, or housekeeping. Occupational therapy helps you resume these life activities. It can be offered as inpatient or outpatient services.
A term that refers to services performed in a provider's office.
This type of dental is a specialist whose practice is limited to diagnosing and performing surgery or associated treatments for diseases, injuries, deformities, and defects of the oral region.
This dental specialty is concerned with the surgical procedures in and about the mouth and jaw.
For a spending account, this is the amount you requested for reimbursement from the account.
These services refer to a dental specialty concerned with the correction of improper alignment of the upper and lower teeth.
A dental specialist, an orthodontist’s practice is limited to treating misaligned teeth and their surrounding structures.
Other insurance paid amount
The amount paid by your other primary insurance.
Out-of-area refers to services members of a Medicare Advantage receive from providers that have no contractual or other relationship with the plan.
This refers to doctors, hospitals, pharmacies, and other healthcare professionals or suppliers who do not belong to a health or drug plan's provider/pharmacy network. See the definition of network.
Generally, an out-of-network benefit gives you the option to use a doctor, specialist, or hospital that is not a part of the plan's contracted network. In some cases, your out-of-pocket costs may be higher for an out-of-network benefit.
A primary care physician or specialist who does not belong to a health plan's provider network is considered an out-of-network doctor. In some cases, your out-of-pocket costs may be higher if you choose to use an out-of-network doctor. See the definition of network.
This is a pharmacy that is not under contract with Humana. By choosing an out-of-network pharmacy, you may pay more through coinsurance. These providers may also bill you for costs that are not covered by your insurance plan. In addition, you will need to meet an out-of-network deductible (separate from your in-network deductible) before Humana begins to pay for covered services.
Also called non-participating provider, this term refers to providers who are not part of the Humana network and, therefore, will cost you more.
These are healthcare costs that you pay on your own because they are not covered by your Medicare plan or other insurance.
This is the annual limit on your costs. After you meet the maximum out-of-pocket amount, your plan pays 100% for covered services. You may still pay copayments. Refer to the plan's Benefits Summary for more details.
Outpatient Prospective Payment System (OPPS)
TRICARE OPPS is used to pay claims for hospital outpatient services. TRICARE OPPS is based on nationally established Ambulatory Payment Classification payment amounts and standardized for geographic wage differences that include operating and capital-related costs, which are directly related and integral to performing a procedure or furnishing a service in a hospital outpatient department. TRICARE OPPS became effective May 1, 2009.
This refers to a service you receive within one day — 24 hours — at a hospital outpatient department or community mental health center.