Physical Therapy Includes treatment by physical means, heat, hydrotherapy or similar modalities, physical agents, bio-mechanical and neuro-physiological principles, and devices to relieve pain, restore maximum function, and prevent disability following disease, injury, or loss of body part. Pulmonary Rehabilitation Therapy Includes treatment through a multidisciplinary program which combines Physical Therapy with an educational process directed towards the stabilization of pulmonary diseases and the improvement of functional status for Chronic Obstructive Pulmonary Disease (COPD). COPD may include, but is not limited to, diagnosis such as emphysema, chronic bronchitis, asthmatic bronchitis, pre-lung transplant and cystic fibrosis. Radiation Therapy The treatment of disease by x-ray, radium, radioactive isotopes, or other radioactive substances regardless of the method of delivery, including the cost of radioactive materials supplied and billed by the Provider. Respiratory Therapy Includes the introduction of dry or moist gases into the lungs for treatment purposes. Coverage will also include services by a respiratory therapist. Speech Therapy Includes treatment for the correction of a speech impairment resulting from disease, Surgery, injury, congenital anomalies, or previous therapeutic processes. Coverage will also include services by a speech therapist. Urgent Care Centers The Claims Administrator will provide coverage for Urgent Care Centers, when Medically Necessary as determined by the Claims Administrator. Urgent Care Centers are designed to offer immediate evaluation and treatment for health conditions that require medical attention: In a non-Emergency situation; That cannot wait to be addressed by the Member's Professional Provider or Retail Clinic. Cost-sharing requirements are specified in the Schedule of Covered Services.
Day Rehabilitation Program A level of Outpatient Care consisting of four to seven hours of daily rehabilitative therapies and other medical services five days per week. The Member returns home: Each evening; and For the entire weekend. Therapies provided may include a combination of therapies, such as: Physical Therapy; Occupational Therapy; and Speech Therapy. Other medical services such as: Nursing services; Psychological therapy; and Case Management services. Day Rehabilitation sessions also include a combination of: One-to-one therapy; and Group therapy. Decision Support Services that help Members make well-informed decisions about Health care and support their ability to follow their Provider's treatment plan. Some examples of support services are: Major treatment choices; and Every day health choices. Deductible A specified amount of Covered Expense for the Covered Services that is Incurred, by the Member, before the Claims Administrator will assume any liability. A specific dollar amount that the Member's Claims Administrator may require that the Member pay out-of pocket each Benefit Period, before the Program begins to make payments for claims. Detoxification The process by which a person who is alcohol or drug intoxicated, or alcohol or drug dependent, is assisted under the following circumstances: In a state licensed Facility Provider; or In the case of opiates, by an appropriately licensed behavioral health provider, in an ambulatory (Outpatient) setting. This treatment process will occur through the period of time necessary to eliminate, by metabolic or other means, any or each of the following problems: The intoxicating alcohol or drug; Alcohol or drug dependency factors; or Alcohol in combination with drugs, as determined by a licensed Physician, while keeping the physiological and psychological risk to the patient at a minimum.