Noncovered Services i. Drugs included in the Food and Drug Administration's Drug Efficacy Study Implementation Program;
Noncovered Services. Services that are not Covered Services. Member may be financially liable to the Medical Services Entity for such services.
Noncovered Services i. Services of assistants at surgery;
Noncovered Services. Medical Services Entity is prohibited from billing the Member for a Noncovered Services and the Member is not responsible therefor unless, prior to rendering the service, Medical Services Entity (i) informed the Member or their personal representative that the specific service is not a Covered Service, and (ii) obtained a signed statement from the Member or their personal representative acknowledging such.
Noncovered Services. A provider may seek payment from the MHCP member for services only when the provider, prior to delivering the service, reviews and discusses all other available covered alternatives with the member and obtains a signed release of liability using the Advance Recipient Notice of Noncovered Service/Item (DHS-3640) (PDF) form. The following services are not covered. This is not an all-inclusive list. Barriers Disposable equipment or supplies Drapes Eye protection Fluoride trays or rinses Gauze or sterile packing Gloves Infection control procedures MinnesotaCare tax Needles Periodontal charting (separate from codes D0150 or D0180) Prescriptions dispensed in the office Prosthetic cleaning Sterilization solutions or equipment Surgical supplies Suture material Syringes Treatment deemed to be cosmetic or for aesthetic reasons Authorization Requirements If a service requires authorization to be covered, follow the guidelines outlined in the Authorization section of the Provider Manual. The Authorization Medical Review Agent must receive all required documentation to complete the review. Verify the member is eligible for FFS and that the service requires authorization before submitting the authorization request to the Medical Review Agent. Refer to MHCP FFS dental authorization charts below for procedure-specific documentation requirements: Children and Pregnant Women Authorization Chart
Noncovered Services. Hypnosis or electroshock therapy, unless personally performed by a licensed practicing physician (M.D.).
Noncovered Services. In the event that Group Participating Provider shall provide Noncovered Services, Group Participating Provider shall, prior to rendering such Noncovered Services, (a) inform the BlueLincs HMO Member that (1) the service(s) to be provided are not covered; (2) BlueLincs HMO will not pay for or be liable for said services; (3) the BlueLincs HMO Member will be financially liable for such services, and (b) obtain a Written Waiver as defined in the Agreement. Such Written Waiver must specifically identify the services for which the BlueLincs HMO Member or his or her representative agrees to be financially responsible and must be executed before Group Participating Provider renders such services.
Noncovered Services. 1. Institutions for Mental Disease (IMD) - The federal definition of an IMD is a hospital, nursing facility, freestanding alcohol treatment center, or other institution of more than sixteen (16) beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases.
Noncovered Services. Services not specifically covered by or eligible for Benefits under the Member’s Benefit Agreement.
Noncovered Services. Drugs prescribed for a condition or treatment that is not covered by this Plan are not covered. However, the Plan does cover Medically Necessary drugs for medical conditions directly related to noncovered services when complications exceed routine Follow-Up Care (such as life-threatening complications of cosmetic surgery). Nonparticipating Pharmacies Drugs dispensed by Nonparticipating Pharmacies are not covered, except as specified in "Nonparticipating Pharmacies and Emergencies" provision of "Covered Services and Supplies," Section 500. Nonprescription (Over-the-Counter) Drugs, Equipment and Supplies Medical equipment and supplies (including insulin), that are available without a prescription, are covered only when prescribed by a Physician for the management and treatment of diabetes, for preventive purposes in accordance with the U.S. Preventive Services Task Force A and B recommendations or for female contraception. Any other nonprescription or over-the-counter drugs, medical equipment or supplies that can be purchased without a Prescription Drug Order is not covered even if a Physician writes a Prescription Drug Order for such drug, equipment or supply unless it is listed in the Recommended Drug List. However, if a higher dosage form of a nonprescription drug or over-the-counter drug is only available by prescription, that higher dosage drug may be covered when Medically Necessary. If a drug that was previously available by prescription becomes available in an over-the-counter (OTC) form in the same prescription strength, then Prescription Drugs that are similar agents and have comparable clinical effect(s), will only be covered when Medically Necessary and Prior Authorization is obtained from Health Net. Physician Is Not a Member Physician Drugs prescribed by a Physician who is not a Member Physician or an authorized Specialist are not covered, except when the Physician's services have been authorized or because of a medical emergency condition, illness or injury or as specifically stated. Quantity Limitations Some drugs are subject to specific quantity limitations per Copayment based on recommendations for use by the FDA or Health Net's usage guidelines. Medications taken on an "as-needed" basis may have a Copayment based on a specific quantity, standard package, vial, ampoule, tube, or other standard unit. In such a case, the amount of medication dispensed may be less than a 30-consecutive-calendar-day supply. If Medically Necessary, your Physicia...
