Organ Transplants. This plan covers organ and tissue transplants when ordered by a physician, is medically necessary, and is not an experimental or investigational procedure. Examples of covered transplant services include but are not limited to: heart, heart-lung, lung, liver, small intestine, pancreas, kidney, cornea, small bowel, and bone marrow. Allogenic bone marrow transplant covered healthcare services include medical and surgical services for the matching participant donor and the recipient. However, Human Leukocyte Antigen testing is covered as indicated in the Summary of Medical Benefits. For details see Human Leukocyte Antigen Testing section. This plan covers high dose chemotherapy and radiation services related to autologous bone marrow transplantation to the extent required under R.I. Law § 27-20-60. See Experimental or Investigational Services in Section 3 for additional information. To speak to a representative in our Case Management Department please call 1-401- 000-0000 or 1-888-727-2300 ext. 2273. The national transplant network program is called the Blue Distinction Centers for Transplants. SM For more information about the Blue Distinction Centers for TransplantsSM call our Customer Service Department or visit our website. When the recipient is a covered member under this plan, the following services are also covered: • obtaining donated organs (including removal from a cadaver); • donor medical and surgical expenses related to obtaining the organ that are integral to the harvesting or directly related to the donation and limited to treatment occurring during the same stay as the harvesting and treatment received during standard post- operative care; and • transportation of the organ from donor to the recipient. The amount you pay for transplant services, for the recipient and eligible donor, is based on the type of service.
Organ Transplants. We cover transplants for heart, heart-lung, lung, liver, small intestine-pancreas, kidney, cornea, small bowel, and bone marrow transplants. Allogenic bone marrow transplant covered health care services include medical and surgical services for the matching participant donor and the recipient. However, Human Leukocyte Antigen testing is covered as indicated in the Summary of Medical Benefits, subject to certain conditions. For details see Section 3.17 - Human Leukocyte Antigen Testing. Medically necessary high dose chemotherapy and radiation services related to autologous bone marrow transplantation is limited. See definition of Experimental/investigational – Section 3.11. To the extent that coverage for bone marrow or stem cell transplantation is more limited than the coverage required by "New Cancer Therapies”, the applicable provisions of the Rhode Island Laws shall govern. See Section 3.11 for the definition of experimental/investigational services. The national transplant network program is called the Blue Distinction Centers for TransplantsSM. For more information about the Blue Distinction Centers for TransplantsSM call our Case Management Department at 0-000-000-0000 or 0-000-000-0000 xxx.
Organ Transplants. This plan covers transplants for heart, heart-lung, lung, liver, small intestine, pancreas, kidney, cornea, small bowel, and bone marrow. Covered healthcare services related to allogenic bone marrow transplant include medical and surgical services for the matching participant donor and the recipient. Human Leukocyte Antigen testing is covered as indicated in the Summary of Medical Benefits. This plan covers high dose chemotherapy and radiation services related to autologous bone marrow transplantation to the extent required under R.I. Law § 27-20-60. See Experimental or Investigational Services in Section 3 for additional information. When the recipient is a covered member under this plan, the following services are also covered: obtaining donated organs (including removal from a cadaver); donor medical and surgical expenses related to obtaining the organ that are integral to the harvesting or directly related to the donation and limited to treatment occurring during the same stay as the harvesting and treatment received during standard post- operative care; and transportation of the organ from donor to the recipient. The amount you pay for transplant services, for the recipient and eligible donor, is based on the type of service. This plan offers access to a national transplant network called the Blue Distinction Centers for Transplants. SM For more information about the Blue Distinction Centers for TransplantsSM call our Case Management Department at 0-000-000-0000 or 1-888-727- 2300 ext. 2273.
Organ Transplants. We cover transplants for heart, heart-lung, lung, liver, small intestine, pancreas, kidney, cornea, small bowel, and bone marrow transplants. Allogenic bone marrow transplant covered health care services include medical and surgical services for the matching participant donor and the recipient. However, Human Leukocyte Antigen testing is covered as indicated in the Summary of Medical Benefits, subject to certain conditions. For details see Section 3.18 - Human Leukocyte Antigen Testing. Medically necessary high dose chemotherapy and radiation services related to autologous bone marrow transplantation is limited. See definition of Experimental/Investigational – Section 8.0. To the extent that coverage for bone marrow or stem cell transplantation is more limited than the coverage required by "New Cancer Therapies”, the applicable provisions of the Rhode Island Laws shall govern. See Section 8.0 for the definition of experimental/investigational services. The national transplant network program is called the Blue Distinction Centers for TransplantsSM . For more information about the Blue Distinction Centers for TransplantsSM call our Case Management Department at 0-000-000-0000 or 1-888-727-2300 ext. 2273. When the recipient is a covered member under this agreement also covers: • obtaining donated organs (including removal from a cadaver); • donor medical and surgical expenses related to obtaining the organ that are integral to the harvesting or directly related to the donation and limited to treatment occurring during the same stay as the harvesting and treatment received during standard post- operative care; and • transportation of the organ from donor to the recipient. The amount you pay for transplant services for the recipient and eligible donor is based on the type of service. For information about office visits see Section 3.24 - Office Visits. For surgical procedures see Section 3.35 - Surgery Services. For lab, radiology, and machine tests see Section 3.37 - Tests, Imaging, and Labs. See the Summary of Medical Benefits for benefit limits. For prescription drugs, see Section 3.28 and Pharmacy Benefits.
Organ Transplants. The PH-MCO will pay for transplants to the extent that the MA FFS Program pays for such transplants. When Medically Necessary, the MA FFS program currently covers the following transplants: Kidney (cadaver and living donor), kidney/pancreas, cornea, heart, heart/lung, single lung, double lung, liver (cadaver and living donor), liver/pancreas, small bowel, pancreas/small bowel, bone marrow, stem cell, pancreas, liver/small bowel transplants, and multivisceral transplants.
Organ Transplants. MCPs must ensure coverage for organ transplants and related services in accordance with OAC 5101-3-2- 07.1 (B)(4)&(5). Coverage for all organ transplant services, except kidney transplants, is contingent upon review and recommendation by the “Ohio Solid Organ Transplant Consortium” based on criteria established by Ohio organ transplant surgeons and authorization from the ODJFS prior authorization unit. Reimbursement for bone marrow transplant and hematapoietic stem cell transplant services, as defined in OAC 3701:84-01, is contingent upon review and recommendation by the “Ohio Hematapoietic Stem Cell Transplant Consortium” again based on criteria established by Ohio experts in the field of bone marrow transplant. While MCPs may require prior authorization for these transplant services, the approval criteria would be limited to confirming the consumer is being considered and/or has been recommended for a transplant by either consortium and authorized by ODJFS. Additionally, in accordance with OAC 5101:3-2-03 (A)(4) all services related to organ donations are covered for the donor recipient when the consumer is Medicaid eligible.
Organ Transplants. The PH-MCO is responsible to pay for transplants to the extent that the MA FFS Program pays for such transplants. When Medically Necessary, the following transplants are the responsibility of the PH-MCO: Kidney (cadaver and living donor), kidney/pancreas, cornea, heart, heart/lung, single lung, double lung, liver (cadaver and living donor), liver/pancreas, small bowel, pancreas/small bowel, bone marrow, stem cell, pancreas, liver/small bowel transplants, and multivisceral transplants.
Organ Transplants. Liver, heart, heart-lung, small intestine and pancreas if treated by covered provider.
Organ Transplants. 16. Elective and/or cosmetic surgery or treatment, whether or not for psychological reasons unless required as the result of injury incurred while this policy is in force.
Organ Transplants. Coverage for transplantation of human organs and tissues is provided only within the Insurer’s Organ Transplant Pro- vider Network. There is no cover- age outside the Organ Transplant Provider Network. The maximum amount payable for this benefit is five hundred thousand ($500,000) per Insured, per lifetime. This organ transplant benefit begins once the need for transplantation has been determined by a provider, has been certified by a second surgi- cal or medical opinion and has been approved by USA Medical Services, and is subject to all the terms, provi- sions and exclusions of the policy. This benefit includes:
