Common use of Reconstructive Surgery Benefits Clause in Contracts

Reconstructive Surgery Benefits. Benefits are available for Reconstructive Surgery services. Benefits include: • Surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to: o Improve function; or o Create a normal appearance to the extent possible; • Dental and orthodontic surgery services directly related to cleft palate repair; and • Surgery and surgically-implanted prosthetic devices in accordance with the Women’s Health and Cancer Rights Act of 1998 (WHCRA). Benefits do not include: • Cosmetic surgery, which is surgery that is performed to alter or reshape normal structures of the body to improve appearance; • Reconstructive Surgery when there is a more appropriate procedure that will be approved; or • Reconstructive Surgery to create a normal appearance when it offers only a minimal improvement in appearance. In accordance with the WHCRA, Reconstructive Surgery, and surgically implanted and non-surgically implanted prosthetic devices (including prosthetic bras), are covered for either breast to restore and achieve symmetry following a mastectomy, and for the treatment of the physical complications of a mastectomy, including lymphedemas. For coverage of prosthetic devices following a mastectomy, see the Durable medical equipment section. Medically Necessary services will be determined by your attending Physician in consultation with you. Benefits will be provided in accordance with guidelines established by Blue Shield and developed in conjunction with plastic and reconstructive surgeons, except as required under the WHCRA.

Reconstructive Surgery Benefits. Benefits are available for Reconstructive Surgery services. Benefits include: •  Surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to: o Improve function; or o Create a normal appearance to the extent possible; •  Dental and orthodontic surgery services directly related to cleft palate repair; and •  Surgery and surgically-implanted prosthetic devices in accordance with the Women’s Health and Cancer Rights Act of 1998 (WHCRA). Benefits do not include: •  Cosmetic surgery, which is surgery that is performed to alter or reshape normal structures of the body to improve appearance; •  Reconstructive Surgery when there is a more appropriate procedure that will be approved; or •  Reconstructive Surgery to create a normal appearance when it offers only a minimal improvement in appearance. In accordance with the WHCRA, Reconstructive Surgery, and surgically implanted and non-surgically implanted prosthetic devices (including prosthetic bras), are covered for either breast to restore and achieve symmetry following a mastectomy, and for the treatment of the physical complications of a mastectomy, including lymphedemas. For coverage of prosthetic devices following a mastectomy, see the Durable medical equipment section. Medically Necessary services will be determined by your attending Physician in consultation with you. Benefits will be provided in accordance with guidelines established by Blue Shield and developed in conjunction with plastic and reconstructive surgeons, except as required under the WHCRA.