Summary of Covered Services for
ViaCare Monterey County
Note: Some links on this page may require Adobe Reader
• Services must be obtained from a participating provider.
Follow the links for more information about your health plan and coverage:
|Category Description||Comments and Limitations|
|Inpatient room and services
Inpatient Physical, Occupational and Speech Therapy
Emergency room (services in and out of the Plan's Service Area and with Contracted and Non-Contracted Providers)
Outpatient surgery - facility
|Some services require prior authorization from the Alliance.|
|You must get primary care services from your Primary Care Provider.
You must have a referral from your Primary Care Provider and prior authorization from the Alliance for specialty care.
|OTHER HEALTH CARE SERVICES|
|AMBULANCE SERVICES||Services are covered as medically necessary.|
|BLOOD AND BLOOD PRODUCTS
(includes collection and storage of autologous blood)
|Services are covered as medically necessary.|
|Some imaging services require prior authorization from the Alliance.|
|DURABLE MEDICAL EQUIPMENT
(includes prosthetics and orthotics)
|You must have a prescription from your Primary Care Provider.
Some supplies and equipment require prior authorization from the Alliance.
|HEARING EXAMS AND SERVICES
Audiology exam and hearing aid instrument
|Requires prior authorization from the Alliance.|
|HOME HEALTH CARE||You must have a prescription from your provider and prior authorization from the Alliance.|
|HOSPICE CARE||Hospice services are covered for members who are diagnosed with a terminal illness and who choose or elect hospice care.|
|MENTAL HEALTH SERVICES
Inpatient hospitalization in an acute care hospital or psychiatric hospital. Requires prior authorization by ViaCare Monterey County.
Crisis and transitional residential services.
Outpatient visits include assessment, individual or group therapy, crisis intervention, medication support and assessment. Requires prior authorization by ViaCare Monterey County.
NON-EMERGENCY MEDICAL TRANSPORTATION
|Benefit is limited to transportation to and from covered medical appointments for members who meet criteria.
Requires prior authorization from the Alliance.
|OUTPATIENT REHABILITATIVE THERAPY SERVICES
|You must have a referral from your Primary Care Provider and prior authorization from the Alliance.|
|PHARMACY SERVICES||You must have a prescription or a provider order. If the prescribed medication is not on the ViaCare Monterey County formulary, prior authorization must be obtained from the Alliance.|
|PODIATRY SERVICES||You must have a referral from your Primary Care Provider and prior authorization from the Alliance.|
|URGENT CARE||Must be provided by your Primary Care Provider when you are inside of Monterey County.|