Common use of Transplant Expense Benefits Clause in Contracts

Transplant Expense Benefits. Covered services for transplant service expenses: Transplants are a covered service when a member is accepted as a transplant candidate and obtains prior authorization in accordance with this contract. Prior authorization must be obtained through the “Center of Excellence” before an evaluation for transplant. We may require additional information such as testing and/or treatment before determining medical necessity for the transplant benefit. Authorization must be obtained prior to performing any related services to the transplant surgery. Transplant services must meet medical criteria as set by Medical Management Policy. Cost share benefit coverage related to transplant services is available to both the recipient and donor of a covered transplant as follows:

Transplant Expense Benefits. Covered services for transplant service expenses: Transplants are a covered service when a member is accepted as a transplant candidate and obtains prior authorization in accordance with this contract. Prior authorization must be obtained through the “Center of Excellence” before an evaluation for transplant. We may require additional information such as testing and/or treatment before determining medical necessity for the transplant benefit. Authorization must be obtained prior to performing any related services to the transplant surgery. Transplant services must meet medical criteria as set by Medical Management PolicyPolicy (as found on our website at xxx.xxxxxxxxxxxxxxxxxx.xxx). Cost share benefit coverage related to transplant services is available to both the recipient and donor of a covered transplant as follows: