PMB Glossary Terms R
Appro-Rx helps improve the way pharmacy benefits management is done every day to help lower prescription costs. However, we understand that the world of PBMs can be confusing. Below we have answered your most frequently asked questions to give you a better understanding of your needs!
Radiation Therapy
Treatment of a disease by x-ray, radium, cobalt, or high-energy particle sources.
Reasonable Charge
The charge for a covered benefit, which is determined by Paramount to be the prevailing charge level, made for the service or supply in the geographic area where it is furnished. Paramount may take into account factors such as the complexity, degree of skill needed, type or specialty of the Provider, range of services provided by a facility, and the prevailing charge in other areas in determining the Reasonable Charge for a service or supply that is unusual or is not often provided in the area or is provided by only a small number of providers in the area.
Referral
Required when referring to a out of network specialists. May also be used for in-network hospital or other services, where appropriate. A referral may be written or electronic
Respiratory Therapy
Treatment of illness or disease that is accomplished by introducing dry or moist gases into the lungs
