Cosmetic Services. We do not Cover cosmetic services or surgery unless otherwise specified, except that cosmetic surgery shall not include reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection or diseases of the involved part, and reconstructive surgery because of congenital disease or anomaly of a covered Child which has resulted in a functional defect , except for cosmetic orthodontics as described in the Dental Care sections of this Contract. Cosmetic surgery does not include surgery determined to be Medically Necessary. If a claim for a procedure listed in 11 NYCRR 56 (e.g., certain plastic surgery and dermatology procedures) is submitted retrospectively and without medical information, any denial will not be subject to the Utilization Review process in the Utilization Review and External Appeal sections of this Contract unless medical information is submitted.
Cosmetic Services. We do not Cover cosmetic services or surgery unless otherwise specified, except that cosmetic surgery shall not include reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection or diseases of the involved part, and reconstructive surgery because of congenital disease or anomaly of a covered Child which has resulted in a functional defect. Cosmetic surgery does not include surgery determined to be Medically Necessary. If a claim for a procedure listed in 11 NYCRR 56 (e.g., certain plastic surgery and dermatology procedures) is submitted retrospectively and without medical information, any denial will not be subject to the Utilization Review process in the Utilization Review and External Appeal sections of this Contract unless medical information is submitted.
Cosmetic Services. Services that are performed to reshape normal structures of the body in order to improve Your appearance and self-esteem and not primarily to restore an impaired function of the body. A service, supply or drug that is eligible for benefits under the terms of this Plan.
Cosmetic Services. This plan does not cover services and supplies for cosmetic services, including but not limited to: Services performed to reshape normal structures of the body in order to improve or alter your appearance and self-esteem and not primarily to restore an impaired function of the body Genital surgery for the purpose of changing genital appearance Breast mastectomy or augmentation with or without chest reconstruction for the purpose of changing breast appearance The only exceptions to this exclusion are: Repair of a defect that is the direct result of an injury, see Surgery Services Repair of a dependent child’s congenital anomaly, see Surgery Services Reconstructive breast surgery in connection with a mastectomy, except as stated under Mastectomy and Breast Reconstruction Services Correction of functional disorders, see Surgery Services This plan does not cover counseling or training in the absence of illness, job help and outreach, social or fitness counseling or training.
Cosmetic Services. This agreement does NOT cover cosmetic procedures. Cosmetic procedures are performed: to refine or reshape dental structures that are not functionally impaired; to change or improve appearance or improve self-esteem; or for other psychological, psychiatric or emotional reasons.
Cosmetic Services. Except for reconstructive services described under section 4.B and for members with severe gender dysphoria, which can be considered medically necessary depending on the unique clinical situation of the member’s condition and life situation, the Plan does not provide Benefits for Cosmetic Services, including but not limited to the following services: a. Abdominoplasty
Cosmetic Services. Except for reconstructive services described under section 4.B.58, the Plan does not provide Benefits for Cosmetic Services.
Cosmetic Services. Christian Science nurses and sanitariums.
Cosmetic Services. Cosmetic Services, including surgery or related Services and other Services for cosmetic purposes to improve appearance, but not to restore bodily function or correct deformity resulting from disease, trauma, or congenital or developmental anomalies. Examples of cosmetic Services include but are not limited to cosmetic dermatology, cosmetic surgical Services and cosmetic dental Services.
Cosmetic Services. I understand and agree that I am ultimately responsible for all payments in full for all cosmetic services. I hereby certify that I have read, understand and agree to the above statements. I have been presented with written treatment plan and fee estimation, and give my full consent to the treatment in the office of Empire Dental.
