QUEST Integration – Hospital and Long-Term Care Facility Visits

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

HMSA’s Plan for QUEST Integration Members covers visits and consultations for patients who are confined in a hospital or long-term care facility, subject to the following limitations:

• Covered visits are limited to one visit per day. This applies whether the patient is in a standard acute care unit, an intensive care unit or a coronary care unit. Should unusual circumstances warrant an additional visit on the same day, please attach documentation explaining these circumstances. Exceptions will be made on a case-by-case basis.
• Covered inpatient consultations are limited to one consultation per admission. Exceptions may be made on a case-by-case basis when the treating physician has asked physicians of different specialties to examine a patient whose symptoms are diverse and possibly related to more than one anatomical system. To facilitate the processing of claims, please submit a copy of the consultation report with your claim.

Revision History