Common use of Tissue and Kidney Transplant Clause in Contracts

Tissue and Kidney Transplant. Benefits are provided for Hospital and professional services provided in connection with human tissue and kidney transplants when the Member is the transplant recipient. Benefits also include services incident to obtaining the human transplant mate- rial from a living donor or a tissue/organ transplant bank. Benefits are provided for certain procedures, listed below, only if (1) performed at a Special Transplant Facility contracting with Blue Shield to provide the procedure, (2) prior authorization is ob- tained, in writing from Blue Shield and (3) the re- cipient of the transplant is a Subscriber or Depen- dent. Benefits include services incident to obtaining the human transplant material from a living donor or an organ transplant bank. Failure to obtain prior written authorization and/or failure to have the procedure performed at a con- tracting Special Transplant Facility will result in denial of claims for this Benefit. The following procedures are eligible for coverage under this Benefit: