Covered Services

As a member of Montgomery County Care, you will get all of the services covered by the program. Please ask your PCP for information on Montgomery County Care covered services.

Covered services include:

• Primary care office visits at Community Health Centers of Greater Dayton, Five Rivers Health Centers or other designated provider
• Specialty care office visits for select services. You must have a referral from your primary care provider so that he or she can coordinate your care. The specialist can consult with you so that you can better understand medical conditions you may have. They may also prescribe medications using the program's prescription formulary. However, Montgomery County Care covers only limited specialist procedures. These include:
  
  • Gastroenterology: colonoscopies and EGDs (examination of the lining of the esophagus, stomach and upper duodenum)
  • Podiatry: foot care for diabetes/vascular deficiency
  • Dermatology: excision and biopsies
  • Cardiology: in-office EKGs
  Members are financially responsible for any procedures not covered by the program. If you or the specialist has questions on what is covered, please call CareSource at 1-877-892-7482. Specialists must have an office in Montgomery County.
• Basic outpatient lab services through Compunet
• Generic-based prescription drug coverage based on a limited formulary, plus selected insulin and diabetic supplies and selected asthma medications
• Case management
• 24-hour nurse advice line
• X-ray services through the Victor J. Cassano Health Center when ordered by your primary care provider

• You should see your PCP for all routine visits like:

  • Regular checkups
  • Colds/flu
  • Earache
  • Rash
  • Sore throat
  • Pain management

  Other things our health professionals can help you with include:

  • Help with understanding your benefits
  • Health education
  • How to get the care you need

  Some services that are not covered under the Montgomery County Care program include:

  • Abortions
  • Acupuncture
  • Alcohol/Substance Abuse (except Behavioral Counseling provided by CHCGD)
  • Allergy Testing/Treatment
  • Ambulance services
  • Bone Density scan
  • Chiropractic services
  • Dental services
  • Dialysis
  • Durable Medical Supplies (with the exception of selected diabetic supplies)
  • Emergency Room services
  • Experimental procedures, treatments or drugs
  • Hearing care, hearing aid services or materials
  • Home Health services or personal care
  • Hospice care
  • Imaging services (except x-ray through Victor J. Cassano Health Center)
  • Infertility services
  • Inpatient hospital services
  • Laboratory services outside of the CHCGD
  • Mammograms (members are referred to community organizations that provide this service to the uninsured)
  • Maternity Health services
  • MRI, PET and CT scans
  • Nursing Home facility care
  • Occupational therapy
  • Office visits, exams, treatments or tests related to documentation of health for employment, insurance, marriage license, school, sports physicals, citizenship or any legal proceeding or court-mandated activity
  • Over-the-counter medicines or supplies (i.e., first aid materials or vitamins)
  • Physical Therapy
  • Prosthetics and orthotics, corrective shoes or wigs
  • Radiation/Chemotherapy services
  • Select laboratory and diagnostic services
  • Services considered to be cosmetic
  • Services or supplies related to sex or gender change
  • Services received before the effective date of coverage or after the termination of enrollment
  • Services that are not medically necessary
  • Speech therapy
  • Transplants
  • Transportation
  • Urgent Care services
  • Vision services
  • Weight reduction services or programs

  If you have questions about your Montgomery County Care benefits, Contact Us.