Transplant Services. Eligibility for Covered Services related to human organ, bone and tissue transplant are as follows. When the Member is the recipient of transplanted human organs, marrow, or tissues, benefits are provided for all Covered Services. Covered Services for Inpatient and Outpatient Care related to the transplant include procedures which are generally accepted as not Experimental/Investigational Services by medical organizations of national reputation. These organizations are recognized by the HMO as having special expertise in the area of medical practice involving transplant procedures. Benefits are also provided for those services which are directly and specifically related to the Member’s covered transplant. This includes services for the examination of such transplanted organs, marrow, or tissue and the processing of blood provided to the Member. The determination of Medical Necessity for transplants will take into account the proposed procedure's suitability for the potential recipient and the availability of an appropriate facility for performing the procedure. Eligibility for Covered Services related to human organ, bone and tissue transplant are as follows. If a human organ or tissue transplant is provided from a donor to a human transplant recipient:
Appears in 10 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
