Page 67 - APPENDICES for Stephen Spero
P. 67
$0 copay
AMBULANCE
Ground ambulance
20% coinsurance
THERAPY SERVICES
Occupational therapy visit
20% coinsurance
Limits apply
Physical therapy & speech & language therapy visit
20% coinsurance
Limits apply
MENTAL HEALTH SERVICES
Outpatient group therapy with a psychiatrist
20% coinsurance
Limits apply
Outpatient individual therapy with a psychiatrist
20% coinsurance
Limits apply
Outpatient group therapy visit
20% coinsurance
Limits apply
Outpatient individual therapy visit
20% coinsurance
Limits apply