Hospital Outpatient Services

Outpatient hospital care must be given by these:

  • Hospitals
  • Rural health clinics

What is a covered service?

  • Emergency room services (for emergent use of hospital ER only)
  • Emergency dental services for members 21 years of age
  • Giving you someone else’s blood
  • Blood products
  • Drugs given in the emergency room
  • Hospital services that can be reasonably done so the patient does not have to stay overnight:
  • Supplies
  • Medical testing
  • X-rays
  • Lab services
  • ER and 23-hour observation stays
  • Physical, occupational and speech therapy
  • Cardiac rehab and pulmonary rehab
  • Radiation therapy
  • Chemotherapy
  • Dialysis
  • Services for dental work when a hospital outpatient facility must be used because of other medical problems or when serious dental work is needed
  • Surgical services (Some surgical services need an approval ahead of time from us.)