Authorized services - When your primary care physician sees you or approves services through other providers, covered services are considered to be authorized.
Copay - A copay is the fixed dollar amount you are required to pay for certain covered services and/or supplies at the time they are received. Examples of services that may require a copay are office visits, outpatient prescription drugs and emergency room care. The amount of copay depends on the type of service or supply. See your contract/certificate for specific copay information.
Covered services - Hospital, physician and other services and supplies for which Premier Blue provides benefit payment. Prior authorization from your PCP is necessary in order to obtain these services.
Summary of Claims Processed (SOCP) - After you receive medical services, you will be sent a Summary of Claims Processed (SOCP). An SOCP is not a bill. Rather, it is a detailed statement Premier Blue sends to members providing information about the payment of a claim. It informs members of the dollar amount (if any) for which they are responsible and also the amount for which Premier Blue is responsible.
Medical emergency - A medical emergency is the sudden and, at the time, unexpected onset of a health condition that you as a prudent layperson (with average knowledge of health and medicine) believe requires immediate medical attention. Your belief is based on the idea that failure to provide medical attention would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person's health in serious jeopardy. Emergency room care should be reserved for medical emergencies. Colds, earaches, minor cuts, sprains and headaches should be treated through your primary care physician.