Special Transplant Benefits. Benefits are provided for certain procedures, listed below, only if (1) performed at a Special Transplant Facility con- tracting with Blue Shield of California to provide the proce- dure or in the case of Members accessing this Benefit outside of California, the procedure is performed at a transplant facil- ity designated by Blue Shield of California, (2) prior authori- zation is obtained, in writing, from Blue Shield of Califor- nia's Medical Director, and (3) the recipient of the transplant is a Subscriber or Dependent. The Plan reserves the right to review all requests for prior authorization of these Special Transplant Benefits, and to make a decision regarding benefits based on (1.) the medical circumstances of each Member, and (2.) consistency between the treatment proposed and Blue Shield of California medical policy. Failure to obtain prior written authorization as described above and/or failure to have the procedure performed at a contracting Special Transplant Facility will result in denial of claims for this Benefit. Benefits are provided for Services incident to obtaining the transplant material from a living donor or an organ transplant bank. The following procedures are eligible for coverage under this provision:
Special Transplant Benefits as specified under Trans- plant Benefits - Special in the Covered Services section.
