What is the Plan definition for the word Physician?
Your health and welfare plan defines Physician as “(a) a physician and surgeon (M.D.) licensed to practice medicine in the state in which he practices and (b) any other practitioner of the healing arts who renders care or treatment within the limits set forth in the license issued to him by the applicable agency of the state in which he renders such care or treatment.” Among the practitioners of the healing arts are Certified Acupuncturists when treatment is for a pain-related diagnosis; nurse midwives for obstetrical care, provided services are performed in a hospital (as defined by the Plan); nurse practitioners; and a licensed Ph.D., M.F.C.C., or L.C.S.W. If you wish to check whether a health care provider fits the definition of Physician, contact the Fund Office.
