Non- Preferred Provider Excluded Services Co- insurance Appeal Co- payment Preauthorization Emergency Room Care Medically Necessary Prescription Drug Coverage SPIRE Hospital Outpatient Care Out-of- pocket Limit Emergency Medical Transportation ICUE Preferred Provider In- network Co- insurance Network DocDNA Skilled Nursing Care ACET Home Health Care In- network Co- payment Reconstructive Surgery Emergency Services Grievance Doc360 ODAR Balance Billing Durable Medical Equipment Cirrus Provider Non- Preferred Provider Excluded Services Co- insurance Appeal Co- payment Preauthorization Emergency Room Care Medically Necessary Prescription Drug Coverage SPIRE Hospital Outpatient Care Out-of- pocket Limit Emergency Medical Transportation ICUE Preferred Provider In- network Co- insurance Network DocDNA Skilled Nursing Care ACET Home Health Care In- network Co- payment Reconstructive Surgery Emergency Services Grievance Doc360 ODAR Balance Billing Durable Medical Equipment Cirrus Provider
(Print)
B-Non-Preferred Provider
G-Excluded Services
O-Co-insurance
B-Appeal
I-Co-payment
B-Preauthorization
I-Emergency Room Care
N-Medically Necessary
I-Prescription Drug Coverage
B-SPIRE
O-Hospital Outpatient Care
G-Out-of-pocket Limit
O-Emergency Medical Transportation
O-ICUE
G-Preferred Provider
G-In-network Co-insurance
I-Network
G-DocDNA
B-Skilled Nursing Care
I-ACET
I-Home Health Care
N-In-network Co-payment
B-Reconstructive Surgery
O-Emergency Services
N-Grievance
N-Doc360
B-ODAR
N-Balance Billing
G-Durable Medical Equipment
I-Cirrus
O-Provider
