Common use of Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic Clause in Contracts

Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic. Devices We cover medically necessary durable medical equipment, medical supplies, and prosthetic devices that meet the minimum specifications. The provider must meet eligibility and credentialing requirements as defined by the plan to be eligible for reimbursement. • can withstand repeated use; • is primarily and customarily used to serve a medical purpose; • is not useful to a person in the absence of an illness or injury; and • is for use in the home. MEDICAL SUPPLIES means those consumable supplies that are disposable and not intended for re-use. Medical supplies require an order by a physician and are essential for the care or treatment of an illness, injury, or congenital defect. Inpatient medically necessary durable medical equipment, medical supplies, enteral formula or food, and prosthetic devices you receive as an inpatient, when provided and billed for by the hospital where you are an inpatient, are covered as a hospital service. See Section 8.0 for the definition of hospital services. When you are prescribed a medically necessary prosthetic device as an inpatient and it is billed by a provider other than the hospital where you are an inpatient, the benefit limits for Medical Equipment, Medical Supplies, and Prosthetic Devices - Outpatient will apply, as shown in the Summary of Medical Benefits.

Durable Medical Equipment, Medical Supplies, Enteral Formula or Food, & Prosthetic. Devices We cover medically necessary durable medical equipment, medical supplies, and prosthetic devices that meet the minimum specifications. The provider must meet eligibility and credentialing requirements as defined by the plan to be eligible for reimbursement. •  can withstand repeated use; •  is primarily and customarily used to serve a medical purpose; •  is not useful to a person in the absence of an illness or injury; and •  is for use in the home. MEDICAL SUPPLIES means those consumable supplies that are disposable and not intended for re-use. Medical supplies require an order by a physician and are essential for the care or treatment of an illness, injury, or congenital defect. Inpatient medically necessary durable medical equipment, medical supplies, enteral formula or food, and prosthetic devices you receive as an inpatient, when provided and billed for by the hospital where you are an inpatient, are covered as a hospital service. See Section 8.0 for the definition of hospital services. When you are prescribed a medically necessary prosthetic device as an inpatient and it is billed by a provider other than the hospital where you are an inpatient, the benefit limits for Medical Equipment, Medical Supplies, and Prosthetic Devices - Outpatient will apply, as shown in the Summary of Medical Benefits.