Services Not Provided
Services Not Provided
Items Not Included in Membership and Requiring Higher Level of Care
- Emergency and Acute Critical Care
- Emergency room visits or hospital admissions
- Management of life-threatening conditions (e.g., heart attack, stroke, severe trauma)
- Advanced imaging (e.g., CT scan, MRI, or specialized diagnostics)
- Specialized Medical Care
- Oncology care (cancer diagnosis and treatment)
- Advanced cardiology services (e.g., echocardiograms, cardiac catheterization)
- Neurology evaluations and procedures
- Rheumatology care for complex autoimmune conditions
Surgical Procedures
- Major surgical interventions (e.g., orthopedic surgery, abdominal surgery)
- Outpatient or inpatient surgical procedures requiring anesthesia
- Pre- and post-operative management beyond routine follow-up
- Advanced Diagnostics and Procedures
- Colonoscopies or endoscopies
- Biopsies requiring specialized equipment or surgical settings
- Sleep studies requiring overnight monitoring
- Sleep studies requiring overnight monitoring
Mental Health
- Psychiatric evaluations or management of severe mental health disorders (e.g., schizophrenia, bipolar disorder)
- Intensive therapy or counseling sessions beyond primary care scope
Chronic Disease Management Requiring Specialists
- Dialysis for kidney failure
- Advanced diabetes management requiring endocrinology care (e.g., insulin pumps)
- Advanced pulmonary care (e.g., CPAP/BiPAP management for sleep apnea)
Reproductive Health
- Fertility evaluations or treatments
- Pregnancy care (including OB-GYN services beyond routine gynecological care)
- Delivery and postpartum care
Advanced Dermatology
- Mohs surgery or other specialized procedures for skin cancer
Other Exclusions
- Durable medical equipment (e.g., CPAP machines, braces, mobility devices)
- Medications not covered by insurance or pharmacy programs
Experimental treatments or procedures
- Legal or administrative services (e.g., medical disability paperwork or expert witness testimony)
Referrals for Specialized Care
- For any conditions or needs outside the scope of the membership, referrals to specialists or higher levels of care will be provided to ensure comprehensive management.
- This clear delineation helps set expectations while emphasizing the value of the membership package.
