Summary of Benefits and Coverage: What this Plan Covers ...
to 20 visits per year per therapy (occupational and physical therapy); no limit applies for speech therapy or pulmonary therapy; limited to 36 visits per year for cardiac therapy. Note: Habilitation therapy limits do not apply when provided for a mental health/substance use disorder diagnosis. Skilled nursing care 30% Coinsurance
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Summary of Benefits and Coverage: What this Plan Covers ...
api.centene.comimaging at other places of service Not covered . Prior authorization may be required. Covered No Limit. Other places of service may include Hospital, Emergency Room, or Outpatient Facility. Failure to obtain prior authorization for any service that requires prior authorization will result in a denial of benefits. See your policy for more details.
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api.centene.comcomplete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact: Arizona Department of Insurance, 100 N. 15th Avenue, Suite 102, Phoenix, AZ 85007-2624, Phone No. 1-602-364-2499 or 1-800-325-2548
Summary of Benefits and Coverage: Coverage Period: 01/01 ...
api.centene.comRetail: $195 Copay / prescription; deductible. does not apply Not covered Prior authorization may be required. Prescription drugs are provided up to 30 days retail and up to 90 days through mail order. Mail orders are subject to 2.5x retail cost-sharing amount. Non …
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api.centene.comRehabilitation. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis. Habilitation services No charge Not covered Prior authorization may be required. Covered No Limit. Skilled nursing care
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Summary of Benefits and Coverage: Coverage Period: 01/01 ...
api.centene.comPrior authorization may be required. Covered No Limit. Other places of service may include Hospital, Emergency Room, or Outpatient Facility. Failure to obtain prior authorization for any service that requires prior authorization will result in a …
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api.centene.comPrior authorization may be required. Covered No Limit. Skilled nursing care 35% Coinsurance. Not covered Prior authorization may be required. Limited to 90 days per year in a facility. Durable medical equipment 35% Coinsurance
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api.centene.com76179IN0110052-01. Ambetter . YOUR HEALTH. OUR PRIORITY. Ambetter from . MHS . provides quality healthcare solutions that can help you live better. With
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