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SURGERY
BENEFITS
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The
physician's fee for inpatient surgery, or surgery done at the doctor's office, or
surgery done on an outpatient basis will be paid at 100% of the amount listed on
the SURGICAL SCHEDULE,
after satisfaction of the Annual Deductible. Follow-up care is included in the surgery charge if applicable.
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EXAMPLE: |
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Surgeon's Charge |
$ 500.00 |
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Surgical Schedule Allowed Amount |
400.00 |
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Fund's Payment |
400.00 |
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Member's Out-of-Pocket Expense |
100.00 |
The
complete SURGICAL SCHEDULE
is too lengthy to publish. If you
require information on a specific surgery, please call or write the Fund Office
for the details you require. You
must have the Relative Values Study (RVS) number, the Current Procedural
Terminology (CPT) code, or a complete description of the
surgery. The complete SURGICAL
SCHEDULE is available from the Fund Office upon request.
For
a better benefit see AHF. |
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ANESTHESIA |
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Fees
for anesthesia services will be reimbursed at 100% of the amount listed in the
Anesthesia Schedule.
The Fund's allowed amount is based on the procedure performed,
complications, and the amount of time involved.
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EXAMPLE: |
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Anesthesiologist's Charge |
$ 700.00 |
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Allowed Amount from Schedule |
600.00 |
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Fund's Payment |
600.00 |
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Member's Out-of-Pocket Expense |
100.00 |
For
a better benefit see AHF.
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ASSISTANT
SURGEON
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If
the procedure REQUIRES an
assistant surgeon, the assistant surgeon will be reimbursed at 20% of the amount
allowed for the surgery, after satisfaction of the Annual Deductible, not to
exceed the assistant's charge. If the only assistant is a Registered Nurse First Assistant (RNFA)
or Physician's Assistant (PA), reimbursement will be at 10% of the amount
allowed for the surgery, after satisfaction of the deductible.
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EXAMPLE: |
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Surgery Allowance |
$ 500.00 |
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Assistant Surgeon's Charge |
125.00 |
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Allowed Amount |
100.00
(20% of Surgery Allowance) |
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Member's Out-of-Pocket Expense |
25.00 |
For
a better benefit see AHF.
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COSMETIC
SURGERY
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| The term "Cosmetic
Surgery" means surgery which is performed merely for the purpose of
improving the appearance of an individual.
The Fund does NOT cover Cosmetic Surgery
unless the surgery is being done to repair disfigurement resulting from an
accident which occurred while the patient was eligible, or for the correction of
a congenital defect in a dependent child, or for breast reconstruction following
mastectomy. |
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