Surgical Dressing. Surgical dressings that require a Practitioner’s/Provider’s prescription, and cannot be purchased over the counter, are Covered when Medically Necessary for the treatment of a wound caused by, or treated by, a surgical procedure. Gradient compression stockings are Covered for: • Severe and persistent swollen and painful varicosities, or lymphedema/edema or venous insufficiency not responsive to simple elevation. • Venous stasis ulcers that have been treated by a Practitioner/Provider or other Healthcare Professional requiring Medically Necessary debridement (wound cleaning). Lymphedema wraps and garments prescribed under the direction of a lymphedema therapist are Covered.
Surgical Dressing. Common disposable medical supplies that can be purchased over the counter such as, but not limited to, bandages, adhesive bandages, gauze (such as four inches by four inches), and elastic wrap bandages are not Covered, except when provided in a Hospital or Practitioner’s/Provider’s office or by a home health professional. Gloves are not Covered, unless part of a wound treatment kit. Elastic Support hose are not Covered.
Surgical Dressing. Surgical dressings that require a Practitioner’s/Provider’s prescription, and cannot be purchased over the counter, are Covered when Medically Necessary for the treatment of a wound caused by, or treated by, a surgical procedure. Gradient compression stockings are Covered for: • Severe and persistent swollen and painful varicosities, or lymphedema/edema or venous insufficiency not responsive to simple elevation. • Venous stasis ulcers that have been treated by a Practitioner/Provider or other Healthcare Professional requiring Medically Necessary debridement (wound cleaning). Lymphedema wraps and garments prescribed under the direction of a lymphedema therapist are Covered. Eyeglasses and Contact Lenses (Limited) The following will only be Covered: • Contact lenses are Covered for the correction of aphakia (those with no lens in the eye) or keratoconus. This includes the Eye Refraction examination. • One pair of standard (non-tinted) eyeglasses (or contact lenses if Medically Necessary) is Covered within 12 months after cataract surgery or when related to Genetic Inborn Error of Metabolism. This includes the Eye Refraction examination, lenses and standard frames. Hearing Aids Hearing Aids and the evaluation for the fitting of Hearing Aids are not Covered except for school-aged children under 18 years old (or under 21 years of age if still attending high school): • Every 36 months per hearing impaired ear for school-aged children under 18 years old (or under 21 years of age if still attending high school). Refer to your Summary of Benefits and Coverage for your Cost Sharing (Deductible, Coinsurance and/or Copayment) amount. • Shall include fitting and dispensing services, including ear molds as necessary to maintain optimal fit, as provided by an In-network Practitioner/Provider licensed in the 5-county area.
Surgical Dressing. Surgical dressings that require a Practitioner’s/Provider’s prescription, and cannot be purchased over the counter, are Covered when Medically Necessary for the treatment of a wound caused by, or treated by, a surgical procedure. Gradient compression stockings are Covered for: • Severe and persistent swollen and painful varicosities, or lymphedema/edema or venous insufficiency not responsive to simple elevation. • Venous stasis ulcers that have been treated by a Practitioner/Provider or other Health Care Professional requiring Medically Necessary debridement (wound cleaning). Lymphedema wraps and garments prescribed under the direction of a lymphedema therapist are Covered. Eyeglasses and Contact Lenses (Limited) The following will only be Covered: • Contact lenses are Covered for the correction of aphakia (those with no lens in the eye) or keratoconus. This includes the Eye Refraction examination. • One pair of standard (non-tinted) eyeglasses (or contact lenses if Medically Necessary) is Covered within 12 months after cataract surgery or when related to Genetic Inborn Error of Metabolism. This includes the Eye Refraction examination, lenses and standard frames.
