These data reflect the most commonly purchased benefits package for each of the health plans in
the year 2000. Coventry/Principal would not supply updated information.

HMO Hospital Outpatient Services
Aetna US Healthcare Covers: Specialist services at participating hospital outpatient departments during office or business hours upon prior written referral by PCP.
Blue Cross Blue Shield Covers: Diagnostic services, therapy services, and other medically necessary services provided at a hospital outpatient department, ambulatory surgery facility or other health care facility.

Limits: Some services require prior approval.

Cost Sharing: Coinsurance applies.
CIGNA / Healthsource See inpatient services
Doctors Health Plan Covers: Same services as for inpatient coverage.

Limits: Requires prior authorization.

Cost Sharing: Copayments may apply.
Generations Covers: Radiological and nuclear medicine, such as x-rays and MRIs. EKGs and EEGs. Also covers laboratory procedures, chemotherapy, radiation therapy, dialysis, anesthesiologist services and surgical procedures with prior authorization.

Limits: Prior authorization must be obtained by the PCP or Participating Specialist for all outpatient surgery and facility procedures.
Optimum Choice Covers:
  • All medically necessary PCP, medical, and surgical specialty services (i.e. anesthesiologists, pathologists, surgical assistants, and radiologists).
  • Outpatient diagnostic services and X-ray services for members who are ambulatory.

Cost sharing: Copayments may apply.
PARTNERS Covers: Same services as inpatient coverage, including radiation therapy, dialysis, chemotherapy, outpatient surgery, and ambulatory surgery center services.
Coventry/Principal Health Care of the Carolinas Covers:
  • X-ray, laboratory and diagnosis.
  • Ambulatory surgery.
  • Physician services, including surgical procedure, consultation with and treatment by specialists and services provided by other licensed medical professionals.
QualChoice Covers: Covered services in the outpatient department of a hospital, as well as those delivered in a health center, diagnostic center or licensed treatment center. This includes birthing centers, ambulatory surgical centers, or hemodialysis centers.
The Wellness Plan of North Carolina, Inc. Covers: Outpatient surgery, diagnostic tests, and therapy services.
United HealthCare Covers: Outpatient surgery performed by a participating physician in a UHC hospital or freestanding facility. Also covers physicians charges, medications, lab and diagnostic tests performed in outpatient setting.

Limits: Lab and diagnostic tests (except mammograms) require prior approval by UHC. Medications cannot exceed a 24-hour supply.

Cost Sharing: Copayments apply to some services.

Excludes: Outpatient hospital services received during regular physician hours, unless the services are necessary because of an emergency.
WellPath Covers: Ambulatory surgery if provided by a participating provider, when referred by PCP and pre-approved by plan.

Cost Sharing: Copayment applies.

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