Required by a Third Party No benefits are provided for physical, psychiatric and psychological exams, treatments and related services that are required by third parties. Some examples of non-covered are: services immunizations; exams and tests required for recreational activities, employment, insurance and school; and courtordered exams and services, except for services. medically necessary Experimental Services and Procedures The benefits described in this Benefit Description are provided only when are covered services furnished in accordance with No benefits are medical technology assessment guidelines. provided for health care charges that are received for or related to care that Blue Cross and Blue considers to be experimental services or procedures. The fact that a treatment is offered as Shield a last resort does not mean that benefits will be provided for it. There are two exceptions to this exclusion. Medex does provide benefits for: One or more stem cell transplants for a who has been diagnosed with breast cancer member that has spread. (These stem cell transplants are not eligible for benefits under Medicare.) Certain used on an off label basis. Some examples are: drugs used to treat cancer; and drugs used to treat HIV/AIDS. For not eligible for benefits under but eligible for benefits Note: covered services Medicare under Medex, determines whether a service is furnished in Blue Cross and Blue Shield accordance with medical technology assessment guidelines. Eye Exams/Eyewear No benefits are provided for eyeglasses and contact lenses, except as described in Part 4, or exams to prescribe, fit or change them. Foot Care No benefits are provided for: Routine foot care services such as trimming of corns, trimming of nails and other hygienic care except when they are covered by and because you have Medicare medically necessary systemic circulatory disease (such as diabetes). Certain nonroutine foot care services and supplies such as: treatment of flat feet or partial dislocations in the feet; foot orthotics, arch supports, shoe (foot) inserts, orthopedic and corrective shoes; and fittings, castings and other services related to devices for the feet. Hearing Aids No benefits are provided for hearing aids or to prescribe, fit or change them. Human Organ and Stem Cell (“Bone Marrow”) Transplants No benefits are provided for the harvesting of the organ or stem cells when the recipient is not a member.
Required by a Third Party No benefits are provided for physical, psychiatric and psychological exams, treatments and related services that are required by third parties. Some examples of non-covered services are: immunizations; exams and tests required for recreational activities, employment, insurance and school; and courtordered exams and services, except for medically necessary services. Experimental Services and Procedures The benefits described in this Benefit Description are provided only when covered services are furnished in accordance with medical technology assessment guidelines. No benefits are provided for health care charges that are received for or related to care that Blue Cross and Blue Shield considers to be experimental services or procedures. The fact that a treatment is offered as a last resort does not mean that benefits will be provided for it. There are two exceptions to this exclusion. Medex does provide benefits for: One or more stem cell transplants for a member who has been diagnosed with breast cancer that has spread. (These stem cell transplants are not eligible for benefits under Medicare.) Certain used on an off label basis. Some examples are: drugs used to treat cancer; and drugs used to treat HIV/AIDS. Note: For covered services not eligible for benefits under Medicare but eligible for benefits under Medex, Blue Cross and Blue Shield determines whether a service is furnished in accordance with medical technology assessment guidelines. Eye Exams/Eyewear No benefits are provided for eyeglasses and contact lenses, except as described in Part 4, or exams to prescribe, fit or change them. Foot Care No benefits are provided for: Routine foot care services such as trimming of corns, trimming of nails and other hygienic care except when they are covered by Medicare and medically necessary because you have systemic circulatory disease (such as diabetes). Certain nonroutine foot care services and supplies such as: treatment of flat feet or partial dislocations in the feet; foot orthotics, arch supports, shoe (foot) inserts, orthopedic and corrective shoes; and fittings, castings and other services related to devices for the feet. Hearing Aids No benefits are provided for hearing aids or to prescribe, fit or change them. Human Organ and Stem Cell (“Bone Marrow”) Transplants No benefits are provided for the harvesting of the organ or stem cells when the recipient is not a member.
ascme2-0601.docx