Nutritional Counseling. Nutritional counseling is covered. It must be prescribed by a physician and performed by a registered dietitian/nutritionist. Nutritional counseling visits may be covered for individuals seeking nutritional information, or for the purpose of treating an illness.
Nutritional Counseling. The Plan provides Benefits for nutritional counseling when required for a diagnosed medical condition.
Nutritional Counseling. Individual- ized nutritional evaluation and counseling for the management of any medical condition for which appropriate diet and eating habits are essential to the overall treatment program is covered when ordered by a physician or physician extender and provided by a licensed health-care professional (e.g., a registered dietitian);
Nutritional Counseling. The Plan provides Benefits for nutritional counseling provided by a licensed dietician when medically necessary for a diagnosed medical or behavioral health condition. Community Health Options may require documentation of a treatment plan and coordination of treatment with the Member’s primary medical and behavioral health providers or treatment team. Preventive services up to 6 visits will be covered at $0 cost share.
Nutritional Counseling. Skilled behavioral health care services provided in the home by a behavioral health provider when ordered by a physician and directly related to an active treatment plan of care established by the physician. All of the following must be met: − The skilled behavioral health care is appropriate for the active treatment of a condition, sickness or disease to avoid placing the covered person at risk for serious complications. − The services are in lieu of a continued confinement in a hospital or residential treatment facility, or receiving outpatient services outside of the home. − The covered person is homebound because of sickness or injury. − The services provided are not primarily for comfort or convenience or custodial in nature. − The services are intermittent or hourly in nature. − The services are not for Applied Behavior Analysis. Benefits for home health care visits are payable up to the home health care maximum. Each visit by a nurse, In figuring the policy year maximum visits, each visit of a: • nurse or therapist, of up to 4 hours, is one visit and • behavioral health provider, of up to 1 hour, is one visit. This maximum will not apply to care given by an R.N. or L.P.N. when: • Care is provided within 7 days of discharge from a hospital or skilled nursing facility as a full-time inpatient; and • Care is needed to transition from the hospital or skilled nursing facility to home care. When the above criteria are met, covered medical expenses include up to 12 hours of continuous care by an R.N. or L.P.N. per day. Whether or not someone is available to give care does not determine whether the services are covered for home health care. The absence of a person to perform a non-skilled or custodial care service does not cause the service to become covered. If the covered person is a minor or an adult who is dependent upon others for non-skilled care (e.g., bathing, eating, toileting), home health care services will only be covered during times when: • there is a family member or caregiver present in the home, and • the family member or caregiver can meet the covered person’s non-skilled needs.
Nutritional Counseling. Individual- ized nutritional evaluation and counseling as for the management of any medical condition for which appropriate diet and eating habits are essential to the overall treatment program when ordered by a physician or physician extender and provided by a licensed health- care professional (e.g., a registered dietitian), up to three (3) sessions annually with a reg- istered dietitian, with physician order. The maximum may be exceeded for an additional three (3) sessions, upon prior authorization by the medical plan, if services beyond the maximum limit are medically necessary. Does not cover individualized nutritional evaluation and counseling for the manage- ment of conditions where appropriate diet and eating habits have not been proven to be essential to the overall treatment program because they are not considered to be medi- cally necessary. Conditions for which nutri- tional evaluation and counseling are not con- sidered to be medically necessary include, but are not limited to, the following:
A. Attention-deficit/hyperactivity dis- order (ADHD);
B. Chronic fatigue syndrome (CFS);
C. Idiopathic environmental intoler- ance (IEI); or
D. Asthma;
Nutritional Counseling. Is covered, as Medically Necessary.
Nutritional Counseling. If checked, provider recommends two nutritional counseling sessions as a part of the patient’s wellness goals to promote a healthier lifestyle. * Applies to employees enrolled in the Patient Centered Medical Home (PCMH) Plan only.
Nutritional Counseling. Call 000-000-0000 to schedule for an appointment with a dietitian.
Nutritional Counseling. Nutritional counseling is not subject to visit limitations. Services related to a healthy diet to prevent obesity are covered as Preventive Services. After Deductible, Member pays nothing Deductible does not apply to first 3 office visits with primary care providers per calendar year Dietary formula for the treatment of phenylketonuria (PKU). After Deductible, Member pays nothing Enteral therapy (elemental formulas) for malabsorption and an eosinophilic gastrointestinal associated disorder. Necessary equipment and supplies for the administration of enteral therapy are covered as Devices, Equipment and Supplies. After Deductible, Member pays nothing Parenteral therapy (total parenteral nutrition). Necessary equipment and supplies for the administration of parenteral therapy are covered as Devices, Equipment and Supplies. After Deductible, Member pays nothing Services directly related to obesity, including bariatric surgery. Services related to obesity screening and counseling are covered as Preventive Services. Not covered; Member pays 100% of all charges Radiation therapy, chemotherapy, oral chemotherapy. See Infusion Therapy for infused medications. Oral Chemotherapy Drugs: After Deductible, Member pays nothing up to a 90-day supply Radiation Therapy and Chemotherapy: After Deductible, Member pays nothing Deductible does not apply to first 3 office visits with primary care providers per calendar year Members age 19 and over – routine eye examinations and refractions, limited to one per calendar year. Eye and contact lens examinations for eye pathology and to monitor Medical Conditions when Medically Necessary. Routine Exams: After Deductible, Member pays nothing Deductible does not apply to first 3 office visits with primary care providers per calendar year Exams for Eye Pathology: After Deductible, Member pays nothing Deductible does not apply to first 3 office visits with primary care providers per calendar year Contact lenses or framed lenses for eye pathology when Medically Necessary. One contact lens per diseased eye in lieu of an intraocular lens is covered following cataract surgery provided the Member has been continuously covered by KFHPWA since such surgery. In the event a Member’s age or medical condition prevents the Member from having an intraocular lens or contact lens, framed lenses are available. Replacement of lenses for eye pathology, including following cataract surgery, is covered only once within a 12 month period and only when needed...
