Many services and procedures today are provided as outpatient in ambulatory service areas of the hospital or at freestanding health services centers.
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How To Receive
Details on how to apply
Obtain a network provider order for outpatient services (unless visiting the emergency department).
Contact the AZ Blue BlueJourney Team at 1-800-446-8331 (TTY 711) for prior authorization.
The ordering provider may help with authorization.
Schedule the services at a network facility selected by the network provider.
It is likely that the scheduling department of that facility will reach out to schedule the services.
The scheduling facility may also help with authorization.
Search network hospitals and select one with the appropriate outpatient services.
Attend the appointment and complete the services.
Engage in recommended follow-up treatment and/or referrals.
Copayments and coinsurance
IN-NETWORK
$125 copayment per visit for services in the emergency department.
Cost-share is waived if admitted to the hospital within one day for the same condition.
$250 copayment per visit for outpatient surgery or procedure.
20% coinsurance for supplies.
$30 copay per individual or group visit for outpatient mental health care.
20% coinsurance per visit for IV therapy or transfusion services (a separate cost-sharing will be assessed for drugs).
20% coinsurance per visit for chemotherapy infusion (a separate cost-sharing will be assessed for drugs).
20% coinsurance for drugs and biologicals that you can’t give yourself.
$25 copayment per visit for hyperbaric oxygen treatment.
OUT-OF-NETWORK
$125 copayment per visit for services in the emergency department.
40% coinsurance per visit for outpatient surgery or procedure.
40% coinsurance for supplies.
40% coinsurance per individual or group visit for outpatient mental health care.
40% coinsurance per visit for IV therapy or transfusion services (a separate cost-sharing will be assessed for drugs).
40% coinsurance per visit for chemotherapy infusion (a separate cost-sharing will be assessed for drugs).
40% coinsurance for drugs and biologicals that you can’t give yourself.
40% coinsurance per visit for hyperbaric oxygen treatment.
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Medically necessary services in the outpatient department of a hospital for diagnosis or treatment of an illness or injury are covered.
Covered services include, but are not limited to
Services in an emergency department or outpatient clinic, such as observation services or ambulatory/outpatient surgery center
Laboratory and diagnostic tests billed by the hospital
Mental health care, including care in a partial-hospitalization program (PHP), if a provider certifies that inpatient treatment would be required without it
X-rays and other radiology services billed by the hospital
Medical supplies such as splints and casts
Certain drugs and biologicals that cannot be self-administered
Unless the provider has written an order for inpatient admission to the hospital, the episode is considered outpatient and cost-sharing amounts for outpatient hospital services apply. Even if there is an overnight hospital stay (rare), it may still be considered outpatient. If outpatient versus inpatient status isn’t clear, ask the hospital staff.
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