2023 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
Page 77
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
Page 77
Benefit Description
Anesthesia
Anesthesia (including acupuncture) for covered medical or surgical services when requested by the attending physician and performed by:
Professional services provided in:
Anesthesia services consist of administration by injection or inhalation of a drug or other anesthetic agent (including acupuncture) to obtain muscular relaxation, loss of sensation, or loss of consciousness.
Note: Anesthesia acupuncture services do not accumulate toward the member’s annual maximum.
Note: See Section 5(c) for our payment levels for anesthesia services billed by a facility.
Standard Option - You Pay
Preferred: 15% of the Plan allowance (deductible applies)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Basic Option - You Pay
Preferred: Nothing
Participating/Non-participating: You pay all charges
Anesthesia
Anesthesia (including acupuncture) for covered medical or surgical services when requested by the attending physician and performed by:
- A certified registered nurse anesthetist (CRNA), or
- A physician other than the physician (or the assistant) performing the covered medical or surgical procedure
Professional services provided in:
- Hospital (inpatient)
- Hospital outpatient department
- Skilled nursing facility
- Ambulatory surgical center
- Residential treatment center
- Office
Anesthesia services consist of administration by injection or inhalation of a drug or other anesthetic agent (including acupuncture) to obtain muscular relaxation, loss of sensation, or loss of consciousness.
Note: Anesthesia acupuncture services do not accumulate toward the member’s annual maximum.
Note: See Section 5(c) for our payment levels for anesthesia services billed by a facility.
Standard Option - You Pay
Preferred: 15% of the Plan allowance (deductible applies)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Basic Option - You Pay
Preferred: Nothing
Participating/Non-participating: You pay all charges
Benefit Description
Not covered:
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges
Not covered:
- Anesthesia related to noncovered surgeries or procedures
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges