MEDICA_®

Outpatient Surgical Services

Description
Any service where something is inserted into or removed from the body for the treatment of a condition, injury, or illness. Medica follows the American Medical Association’s (AMA) guidelines as to what is considered a surgical service. Visit the AMA's Web site for a definition of surgical services.

What are the ways that this is covered?

• Outpatient Surgical Services

Where do I find out how this will be covered with my benefit plan?

• Surgical Services will be found in the Professional/Physician Services section of your benefit document. It will be paid under the surgical services received from a physician during an office visit, outpatient hospital visit, or ambulatory surgical center visit section.

Things to remember

• If any type of anesthesia is used during the procedure, you will find your benefits in the Professional/Physician Services section of your benefit document. It will be paid under the anesthesia services received from a provider during an office visit, outpatient hospital visit, or ambulatory surgical center visit section.
• If the procedure takes place in an outpatient hospital or ambulatory surgical center, you will also have facility charges. The facility charges will be found in the Hospital Services section of your benefit document under other outpatient services.
• Below are some common examples of services that are considered surgical:
  • Earwax removal
  • Wart removal
  • Application and removal of a cast
  • Mole removal
  • Knee replacement
  • Tonsil removal
  • ACL repair
• If you have any further questions regarding your benefits, please contact Customer Service at the number on the back of your ID card.

Return to Coverage Guidelines.