1710 search results for Out
- St.James
- https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/st-james.pdf?sfvrsn=7df27452_12
- Talk with Plan Talk with Plan
Chemo Drugs
20%
30%
20%
30%
20%
17%-20%
20%
Out-of-Pocket, Consolidated
Premium
$0 $59 $31 $169
Health Plan Deductible $500 Out-of-network $500 Out-of-network Cpntact Plan $500 Out-of-network
PCP Co-Pay
$35 or 0%- 20%
50%
$20 or 0%- 20%
50%
$10 or 20%
$15, with Plan
Chemo Drugs
20%
50%
20%
50%
20%
20%
50%
Out-of-Pocket Maximum $6,700 $5,500 $6,700, Drugs 20% 20% 20%
Out-of-Pocket Maximum $6,700 $6,700 $6,700
2018 Medicare Advantage Plans
St
- St.Landry
- https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/st-landry.pdf?sfvrsn=78f27452_12
- with Plan Talk with Plan
Chemo Drugs
20%
30%
20%
30%
20%
17%-20%
20%
Out-of-Pocket Maximum, Plan Deductible $1000 annual deductible $500 Out-of-network $500 Out-of-network Contact Plan
PCP Co, %
20%
50%
20%
50%
20%
Out of Pocket Maximum $6,700 / $10,000 $6,700 $5,500 $6,700
2018 Medicare, Local HMO
Monthly Consolidated
Premium
$169 $0 $0 $0
Health Plan Deductible $500 Out-of-network $0, with Plan
Chemo Drugs
20%
50%
20% 20% 20%
Out of Pocket Maximum $3,000 $6,700 $6,700 $6,700
2018
- St.Martin
- https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/st-martin.pdf?sfvrsn=79f27452_12
- Drugs not covered Talk with Plan
Chemo Drugs 20% 20% 20% 20%/30%
Out-of-Pocket Maximum $6,700,
$87 $47 $0 $0
Health Plan Deductible $1,000 annual deductible $1000 annual deductible $0 $500 Out, % (Part B) 20% (Part B) 20%/50%
Out of Pocket Maximum $6,700/ $10,000 $6,700 / $10,000 $6,700 $6,700, $500 Out-of-network $500 Out-of-network Contact Plan $0
PCP Co-Pay $15 0%- 20% $20 0%- 20%/50% $10, )
Out of Pocket Maximum $3,000 $5,500 $6,700 $6,700
2018 Medicare Advantage Plans
St. Martin
- Tangipahoa
- https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/tangipahoa.pdf?sfvrsn=6bf27452_12
- Yes Yes Yes Drugs not covered
Chemo Drugs 20% 20% 20% (Part B) 20%/30%
Out-of-Pocket Maximum $6,700, $500 Out-of -Network
PCP Co-Pay $15/30% $15 $5 $20 or 0-20% /50%
Specialist Co-Pay $50/30% $50/$40, %(Part B)
Out-of-Pocket Maximum $6,700/ $10,000 $6,700/ $10,000 $6,700 $5,500
2018 Medicare Advantage, $500 Out-of-Network $183 per year $500 Out of Network
PCP Co-Pay $15 or 0-20% | POS 50% $10 0%- 20,
Additional Coverage in the Gap Yes Yes Yes
Chemo Drugs 20% (Part B) 20% 20%
Out-of-Pocket Maximum
- Terrebonne
- https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/terrebonne.pdf?sfvrsn=50f27452_12
- coverage
Chemo Drugs 20% (Part B) 20% (Part B) 20% / 30% (Part B) 20% / 30%
Out-of-Pocket Maximum $6,700, Deductible $0 $166 annual deductible
$350 Out-of-Network
deductible
$350 Out-of-Network
deductible, % (Part B)
Out of Pocket Maximum $6,700 $6,700 $5,900 $3,600
2018 Medicare Advantage Plans
Terrebonne,
$0
Health Plan Deductible
$350 Out-of-Network
deductible
PCP Co-Pay $25 or 0-20% | POS 50, on certain
Tiers)
Additional Coverage in the Gap No Gap coverage
Chemo Drugs 20% (Part B)
Out
- West Feliciana
- https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/west-feliciana.pdf?sfvrsn=31f27452_12
- not covered Talk with Plan Drugs not covered
Chemo Drugs 20% 20% 20% 20%/30%
Out-of-Pocket Maximum,
Chemo Drugs 20%- 30% 20%/ 17%-20% 20% 20%
Out of Pocket Maximum $6,700/ $10,000 $6,700/ $10,000, $500 out-of-network $500 out of network $500 out-of-network $0
PCP Co-Pay $20 20or 0-20%-50% $15 or 0, % 20%/50% 20%
Out of Pocket Maximum $5,500 $3,000 $6,700 $6,700
2018 Medicare Advantage Plans
West
- St.John the Baptist
- https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/st-john-the-baptist.pdf?sfvrsn=7ff27452_18
- not covered Talk with Plan Talk with Plan Talk with Plan
Chemo Drugs 20% 20% 20% 20% (Part B)
Out, Local HMO
Monthly Consolidated
Premium
$0 $59 $31 $169
Health Plan Deductible $500 Out-of-network $500 Out-of-network $183 per year $500 Out-of-network
PCP Co-Pay $35 0%- 20% $20 0%- 20% $10 0, %
Out of Pocket Maximum $6,700 $5,500 $6,700 $3,000
2018 Medicare Advantage Plans
St John, % (Part B) 20% 20%
Out of Pocket Maximum $6,700 $6,700 $6,700
- Vermilion
- https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/vermilion.pdf?sfvrsn=44f27452_18
-
Additional Coverage in the Gap Yes Yes Yes Drugs not covered
Chemo Drugs 20% 20% 20% 20%/30%
Out,
$53 $87 $59 $169
Health Plan Deductible $1,000 annual deductible $1,000 annual deductible $500 Out of network $500 Out‐of network
PCP Co‐Pay $15/30% $15 $20 / 0%‐ 20%/50% $10 0%‐ 20%
Specialist Co, % ‐ 50%
Out‐of‐Pocket Maximum $6,700/ $10,000 $6,700/ $10,000 $5,500 $3,000
2018 Medicare,
Health Plan Deductible $183 per year $500 Out‐of network
PCP Co‐Pay $10 0%‐ 20% $35 or 0‐20
- Rule25-Cur-SuspensionOfCertainS
- https://ldi.la.gov/docs/default-source/documents/legaldocs/rules/rule25-cur-suspensionofcertains.pdf?sfvrsn=daff7352_6
- . Applying Provisions outside of Affected Parishes
A. Nothing in Emergency Rule 24 shall preclude, restrictions relative to out-of-nelwork access to all
covered health careservices. To avoid delays,
businessinLouisianaorregulatedbythecommissionershall
waive any and all restrictions relative to out-of-network, of
Insurance. Office of the Commissioner. LR 34:
§4545. Applying Provisions outside of Affected
- LDI 48 Administrative Actions and Fines (000588-000622)
- https://ldi.la.gov/docs/default-source/documents/legaldocs/public-comments-dec23/ldi/ldi-48-administrative-actions-and-fines-(000588-000622).pdf?sfvrsn=d8ac4552_0
- room
claims.
G. Failure to maintain proper controls for the payment of out of
network claims.
H, and processing
errors regarding claims from in network providers processing as
out-of-network, . Improper denial of the out-of-area emergency room services.
C. Failed to adequately consider, the correct maximum
amounts for in-network deductibles or out-of-pocket expenses on
the Explanation, to be contributing to operational results
that produced differing outcomes.
(a) Auto-Adjudication denial rates