IQVIA Benefits Handbook
PHYSICIAN SERVICES
Covered medical expenses include charges made by a physician during a visit to treat an illness or injury. The visit may be at the physician's office, in your home, in a hospital or other facility during your stay or in an outpatient facility.
Covered services also include:
  • Care such as consultations and second surgical opinions.
  • Office surgery.
  • Radiological services, X-rays and tests.
  • Medical supplies.
  • Allergy treatment/injections and allergy serums.
  • Assistant surgeon and co-surgeon charges:
    • The maximum amount payable will be limited to charges made by an assistant surgeon that does not exceed a percentage of the surgeon's allowable charge as specified in Aetna or Kaiser Reimbursement Policies. (For purposes of this limitation, allowable charge means the amount payable to the surgeon prior to any reductions due to coinsurance or deductible amounts.)
    • The maximum amount payable for charges made by co-surgeons will be limited to the amount specified in Aetna or Kaiser Reimbursement Policies.