Network
20% coinsurance after deductible
Non-Network
40% coinsurance after deductible
Network
Inpatient: $200 copayment plus 20% coinsurance after deductible
Other: 20% coinsurance after deductible
Non-Network
40% coinsurance after deductible
Network
Inpatient: $200 copayment plus 20% coinsurance after deductible
Other: 20% coinsurance after deductible
Non-Network
40% coinsurance after deductible
Covered benefits include:
Certain types of services such as radiology, anesthesiology and pathology are sometimes performed by non-network providers in a network facility. Expenses for these services are paid as network benefits and are not subject to UCR.
Except for observation, preauthorization by medical plan is required.
See also: Mental Health Services (Includes Inpatient and Outpatient)
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