Prosthetic Appliances Benefits. The Member’s initial provision and replacement of a prosthetic device that temporarily or permanently replaces all or part of an external body part lost or impaired as a result of disease or injury or congenital defects is covered, when such device is prescribed by a Participating Provider, administered through a Participating or designated prosthetic Provider and pre-authorized by HMO. Coverage includes repair and replacement when due to congenital growth. Instruction and appropriate services required for the Member to properly use the item (such as attachment or insertion) are covered. Covered prosthetic appliances include those items covered by Medicare unless excluded in the Exclusions and Limitations section of this Certificate. HMO reserves the right to provide the most cost efficient and least restrictive level of service or item which can be safely and effectively provided.
Prosthetic Appliances Benefits. Benefits are provided for Prostheses for Activities of Daily Living at the most cost-effective level of care that is consistent with professionally recognized standards of practice. If there are two or more professionally recognized Prosthetic appliances equally appropriate for a condition, Benefits will be based on the most cost-effective Prosthetic appliance. Benefits include:
1) xxxx-Xxxxxx and artificial larynx prostheses for speech following a laryngectomy (covered as a surgical professional benefit);
2) artificial limbs and eyes;
3) internally implanted devices such as pacemakers, intraocular lenses, cochlear implants, osseointegrated hearing devices and hip joints if surgery to implant the device is covered;
4) contact lenses to treat eye conditions such as keratoconus or keratitis sicca, aniridia, or aphakia following cataract surgery when no intraocular lens has been implanted. ;
5) supplies necessary for the operation of prostheses;
6) initial fitting and replacement after the expected life of the item; and
Prosthetic Appliances Benefits. The Member’s initial provision and replacement of a prosthetic device that temporarily or permanently replaces all or part of an external body part lost or impaired as a result of disease or injury or congenital defects is covered, when such device is prescribed by a Participating Provider, administered through a Participating or designated prosthetic Provider and pre-authorized by HMO including at least two (2) external breast prostheses subsequent to a covered mastectomy. Coverage includes repair and replacement when due to congenital growth. Instruction and appropriate services required for the Member to properly use the item (such as attachment or insertion) are covered. Covered prosthetic appliances include those items covered by Medicare unless excluded in the Exclusions and Limitations section of this Certificate. HMO reserves the right to provide the most cost efficient and least restrictive level of service or item which can be safely and effectively provided.
Prosthetic Appliances Benefits. The Member’s initial provision and replacement of a prosthetic device, including a breast prosthesis, that temporarily or permanently replaces all or part of an external body part lost or impaired as a result of disease or injury or congenital defects is a Covered Benefit, when such device is prescribed by a Participating Provider, administered through a Participating or designated prosthetic Provider and pre- authorized by HMO. The Covered Benefit includes repair and replacement when due to congenital growth. Instruction and appropriate services required for the Member to properly use the item (such as attachment or insertion) are Covered Benefits. Covered prosthetic appliances include those items covered by Medicare unless excluded in the Exclusions and Limitations section of this Certificate.
Prosthetic Appliances Benefits. The Member’s initial provision of a prosthetic device that temporarily or permanently replaces all or part of an external body part lost or impaired as a result of disease or injury or congenital defects is covered, when such device is prescribed by a Participating Provider and authorized in advance by HMO. Coverage includes repair and replacement when due to congenital growth. Instruction and appropriate services required for the Member to properly use the item (such as attachment or insertion) are covered. Replacement prosthetic devices that temporarily or permanently replace all or part of an external body part lost or impaired as a result of disease or injury or congenital defects are covered, when such devices are prescribed by a Participating Provider and authorized in advance by HMO. Coverage includes repair and replacement when due to congenital growth. Instruction and appropriate services required for the Member to properly use the item (such as attachment or insertion) are covered.
Prosthetic Appliances Benefits. The Member’s initial provision and replacement of a prosthetic device that temporarily or permanently replaces all or part of an external body part lost or impaired as a result of disease or injury or congenital defects is covered, when such device is prescribed by a Participating Provider, administered through a Participating or designated prosthetic Provider and pre- authorized by HMO. Coverage includes repair and replacement when due to congenital growth, repairs and replacements of prosthetic arms and legs Instruction and appropriate services required for the Member to properly use the item (such as attachment or insertion) are covered. Covered prosthetic appliances include those items covered by Medicare unless excluded in the Exclusions and Limitations section of this Certificate. HMO reserves the right to provide the most cost efficient and least restrictive level of service or item which can be safely and effectively provided. Reconstructive breast Surgery resulting from a mastectomy is covered. Coverage includes reconstruction of the breast on which the mastectomy is performed including areolar reconstruction and the insertion of a breast implant; Surgery and reconstruction performed on the non-diseased breast to establish symmetry when reconstructive breast Surgery on the diseased breast has been performed; and Medically Necessary physical therapy to treat the complications of mastectomy, including lymphedema. Subject to payment of the applicable Copayment, the following equipment, supplies and education services for the treatment of insulin treated diabetes; non-insulin treated diabetes; and gestational diabetes conditions are covered when Medically Necessary and when prescribed or ordered by a Participating PCP (or Participating nurse practitioner or clinical nurse Specialist) and obtained through a Participating Provider: blood glucose monitors and blood glucose monitors for the legally blind management systems; test strips for glucose monitors and/or visual reading; insulin; injection aids; cartridges for the legally blind; syringes; insulin pumps and appurtenances thereto; insulin infusion devices, oral agents for controlling blood sugar; and therapeutic/molded shoes for the prevention of amputation. Coverage also includes diabetes self-management education to ensure that Members with diabetes are instructed as to the proper self-management and treatment of their diabetic condition, including information on the nutr...
Prosthetic Appliances Benefits. The Member’s initial provision and replacement of a prosthetic device that temporarily or permanently replaces all or part of an external body part lost or impaired as a result of disease or injury or congenital defects is covered, when such device is prescribed by a Participating Provider, administered through a Participating or designated prosthetic Provider and pre-authorized by HMO’s Medical Director or Designee. Coverage includes repair and replacement when due to congenital growth. Instruction and appropriate services required for the Member to properly use the item (such as attachment or insertion) are covered. Covered prosthetic appliances include those items covered by Medicare unless excluded in the Exclusions and Limitations section of this Certificate. HMO reserves the right to provide the most cost efficient and least restrictive level of service or item which can be safely and effectively provided.
