Outpatient hospital visits are subject to a $0 or 20% copay. A $35 copay applies to therapy visits (occupational, physical, speech, and language). Ambulance services are covered with a $295 copay. The ER and Urgent Care copays are $90 and $35. Lab services are subje...
OTHER ELIGIBLE PROVIDERS The following class of providers do not enter into Participating agreements with us and your payment responsibility for these providers is as indicated below: a blood bank, a Dentist (D.D.S.), a dispensing optician, a speech pathologist, an audiologist, a respiratory ...