Hospital Services
The Plan covers various inpatient and outpatient hospital services and supplies. These services include hospital room and board, operating or treatment rooms, and other essential medical services.
Hospital room and board (including dietary and general nursing services)
Operating or treatment rooms
Anesthetics and their administration
Intravenous injections and solutions
Physical, occupational, and speech therapy
Radiation therapy
Oxygen and its administration
Diagnostic services
Intensive, coronary, and burn care unit services
Drugs and medicines (used during hospitalization, including charges for take-home drugs)
Dressings and supplies
Blood transfusions (including the cost of whole blood, blood plasma, and expanders)
Psychological testing
All inpatient admissions except routine maternity admissions require certification by Acentra. Inpatient rehabilitative services are limited to acute short-term care in a hospital or rehabilitation hospital, as approved by Acentra. Refer to the Medical Management and Utilization Review section for certification requirements.
Long-Term Acute Care Facility
All admissions to a long-term acute care facility must be certified as medically necessary by Acentra.
Ambulatory Surgical Facility
Ambulatory surgical facility services include pre-operative laboratory procedures directly related to a surgical procedure, pre-operative preparation, use of facility (including operating rooms, recovery rooms, and surgical equipment), anesthesia, drugs, and surgical supplies.
Skilled Nursing Facility
All admissions and continued stays in a skilled nursing facility must be certified as medically necessary by Acentra. Refer to the Medical Management and Utilization Review section for certification requirements.
Residential Treatment Facility
All admissions and continued stays in a residential treatment facility must be certified as medically necessary by Acentra. Refer to the Medical Management and Utilization Review section for certification requirements.