Reconstructive Surgery. Benefits for reconstructive surgery are limited to surgical procedures that are Medically Necessary, as determined by CareFirst BlueChoice, and operative procedures performed on structures of the body to improve or restore bodily function or to correct a deformity resulting from disease, trauma, or previous therapeutic intervention.
Reconstructive Surgery. Reconstructive Surgery is surgery: • Which restores features damaged as a result of injury or illness • To correct a congenital deformity or anomaly. The service area for this plan is Washington State, excluding Xxxxx County.
Reconstructive Surgery. This benefit has one or more exclusions as specified in the Exclusions Section. Reconstructive Surgery from which an improvement in physiological function can reasonably be expected will be Covered if performed for the correction of functional disorders. Reconstructive Surgery must be prescribed by a Member’s Practitioner/Provider and requires Prior Authorization. For information regarding Reconstructive Surgery following a Mastectomy and Prophylactic Mastectomy, refer to the Women’s Healthcare Section.
Reconstructive Surgery. This benefit has one or more exclusions as specified in the Exclusions Section. Reconstructive Surgery from which an improvement in physiological function can reasonably be expected will be Covered if performed for the correction of functional disorders. Reconstructive Surgery must be prescribed by a Member’s Practitioner/Provider and requires Prior Authorization. For information regarding Reconstructive Surgery following a Mastectomy and Prophylactic Mastectomy, refer to the Women’s Healthcare Section. Reconstructive surgery related to Gender Confirmatory Therapy and Gender Affirming Care are Covered. The Prior Authorization criteria of this Plan is applicable This benefit has one or more exclusions as specified in the Exclusions Section.
Reconstructive Surgery. The insurer will cover the actual incurred medical cost of the reconstructive surgery required to restore natural function or appearance following an accident or following a surgical procedure for an eligible medical condition, which occurred after an insured person’s entry date or start date whichever is later. The maximum benefits should be mutually agreed between the policyholder and the insurer and stipulated in the insurance contract.
Reconstructive Surgery. This is limited to reconstructive surgery, incidental to or following surgery, resulting from injury or illness of the involved part, or to correct a congenital disease or anomaly resulting in functional defect in a dependent child, as determined by the attending physician.
Reconstructive Surgery. We cover reconstructive surgery. This shall include plastic, cosmetic and related procedures required to:
(a) to correct significant disfigurement resulting from an injury or Medically Necessary surgery, (b) to correct a congenital defect, disease, or anomaly in order to produce significant improvement in physical function, and (c) to treat congenital hemangioma known as port wine stains on the face for Members age 18 or younger. Following mastectomy, we also cover reconstructive breast surgery and all stages of reconstruction of the other breast to produce a symmetrical appearance, and treatment of physical complications, including lymphedemas. Mastectomy is the surgical removal of all or part of a breast as a result of breast cancer. Reconstructive breast surgery is surgery performed as a result of a mastectomy to reestablish symmetry between the two breasts. Reconstructive breast surgery includes augmentation mammoplasty, reduction mammoplasty, and mastopexy. Reconstructive Surgery Exclusions: • Cosmetic surgery, plastic surgery, or other Services, supplies, dermatological preparations and ointments, other than those listed above, that are intended primarily to improve your appearance, or are not likely to result in significant improvement in physical function, and are not Medically Necessary. Examples of excluded cosmetic dermatology services are: • Removal of moles or other benign skin growths for appearance only. • Chemical Peels. • Xxxxxxx earlobe repairs, except for the repair of an acute bleeding laceration.
Reconstructive Surgery. This benefit has one or more exclusions as specified in the Exclusions Section. Reconstructive Surgery from which an improvement in physiological function can reasonably be expected will be provided if performed for the correction of functional disorders. For example, when a scar does not allow full function of a hand and a surgical procedure to remove the scar will achieve full function.
Reconstructive Surgery. (Please refer to the Benefit Schedule for other benefit provisions which may apply.)
Reconstructive Surgery. This benefit has one or more exclusions as specified in the Exclusions Section. Reconstructive Surgery from which an improvement in physiological function can reasonably be expected will be Covered if performed for the correction of functional disorders. Reconstructive Surgery must be prescribed by a Member’s Practitioner/Provider and requires Prior Authorization. For information regarding Reconstructive Surgery following a Mastectomy and Prophylactic Mastectomy, refer to the Women’s Healthcare Section. Reconstructive surgery related to Gender Confirmatory therapy and Gender Affirming Care are Covered. The Prior Authorization criteria of this Plan is applicable. This benefit has one or more exclusions as specified in the Exclusions Section. Cardiac Rehabilitation benefits are available for continuous electrocardiogram (ECG) monitoring, progressive exercises and intermittent ECG monitoring. Refer to the rehabilitation and habilitation section of your Summary of Benefits and Coverage for your Cost Sharing amount. Pulmonary Rehabilitation benefits are available for progressive exercises and monitoring of pulmonary functions. Refer to the rehabilitation and habilitation section of your Summary of Benefits and Coverage for your Cost Sharing amount. Short-term Rehabilitation benefits are available for physical therapy, occupational therapy, and speech therapy, provided in a Rehabilitation Facility, Skilled Nursing Facility, Home Health Agency, or Outpatient setting. Short-term Rehabilitation is designed to assist you in restoring functions that were lost or diminished due to a specific episode of illness or injury (for example, stroke, motor vehicle accident, or heart attack). Coverage is subject to the following requirements and limitations: • Presbyterian will not impose a member cost share for physical rehabilitation services that is greater than that for primary care services on a coinsurance percentage basis when coinsurance is applicable or if a copay is applicable. The services must be performed by, or under the direction of a licensed physical therapist, occupational therapist or speech therapist. • Outpatient physical and occupational therapy require that your Primary Care Practitioner or other appropriate treating Practitioner/Provider must determine in advance that Rehabilitation Services can be expected to result in Significant Improvement in your condition. Refer to the rehabilitation and habilitation section of your Summary of Benefits and Coverage...
