MAP Covered Benefits and Copays

PostedJanuary 8, 2018

Last Updated OnMarch 8, 2018

ByMonica Montes

Use the Contacts Module to record calls from patients regarding benefits/copays under “Request for Information” and select MAP Benefits-Patients as referral.
MAP Covered Services:	Co-payment:
PHYSICIAN SERVICES Primary and preventive care (Primary Care Provider) Specialty physician Urgent Care Convenient Care	$10 Co-payment per visit
HOSPITAL IN-PATIENT SERVICES Requires that you get pre-approval from your doctor, except for emergencies threatening life or limb Hospital room Operating room/recovery room X-ray, laboratory, diagnostic, and therapeutic services Medications Intensive care/coronary care Physician hospital visits and care Surgery services	$30 Co-payment per visit
OUTPATIENT SERVICES Requires that your doctor get pre-approval from MAP for your services Surgery services (including Day Surgery) Occupational therapy (co-payment for therapy is a one-time charge per incident that covers all visits in the treatment plan) Physical therapy (co-payment for therapy is a one-time charge per incident that covers all visits in the treatment plan) Speech therapy (co-payment for therapy is a one-time charge per incident that covers all visits in the treatment plan)	$10 Co-payment per visit $10 Co-payment per incident $10 Co-payment per incident
DIAGNOSTIC X-RAYS AND LABORATORY	$0 Co-payment per visit
HOME HEALTH SERVICES, LIMITED MEDICAL EQUIPMENT and MEDICAL SUPPLIES Requires that your provider get pre-approval from MAP for your services	$0 Co-payment per visit
URGENT CARE/CONVENIENTCARE Non-life threatening emergency that requires care within 24 hours, patient utilizes designated Urgent or Convenient Care Clinic	$10 Co-payment per visit
EMERGENCY CARE Only use the Emergency Room when you have a true emergency!	$25 Co-payment per visit
DENTAL SERVICES Emergency and urgent dental services. General dental services include prophylaxis, x-ray, exam, filling and extraction. Limited specialty services include: oral surgery, limited pedodontics, and limited endodontics Partial dentures Full dentures	$10 Co-payment per visit $35 Co-payment (per partial) $50 Co-payment (per plate)
TRANSPORTATION SERVICES Call 911 for emergencies that threaten life or limb Local emergency ambulance transportation only	$0 Co-payment
PRESCRIPTION DRUG SERVICES Prescriptions and disposable supplies (e.g., insulin syringes, chemstrips, etc.). Refer to Pharmacies under the Flyers and Forms Menu.	Formulary Drugs $7 co-pay for 1-30 day supply $14 co-pay for 31-90 day supply (selected drugs only) $0 co-pay if homeless Non-Formulary Drugs $10 co-pay $0 co-pay if homeless