Surgery Services. This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.
Surgery Services. For diagnostic imaging, lab, and machine tests see Section 3.37.
Surgery Services. If you are admitted to a general hospital as an inpatient for a medical condition, we cover the services of a doctor in charge of your medical care, up to one (1) visit per day. If you are admitted for surgical, obstetrical, or radiation services, our allowance to the doctors who performed your surgery, delivered your child, or supervised your radiation includes payment for all your related hospital visits by these doctors during your admission. If, while you are in the hospital, the attending doctor in charge of your care asks for the assistance of a doctor who has special skills and knowledge to diagnose your condition, we cover a consultation performed by a specialist. The transferring of a patient from one doctor to another is not considered to be a consultation. A specialized doctor who then treats you as his or her patient is not considered to be a consultant If you need inpatient specialty care for a condition that requires skills the doctor in charge of your care does not have, we will cover specialist visits as medically necessary.
Surgery Services. For a specialist exam, see Section 3.24 - Office Visits. For diagnostic imaging, lab and machine tests see Section 3.37. See the Summary of Medical Benefits for benefit limits and the amount that you pay for each type of service. If you are admitted to a non-network hospital from the emergency room, BCBSRI recommends you obtain preauthorization to receive inpatient services. Call our Customer Service Department at (000) 000-0000 or 0-000-000-0000 with any questions you have about your coverage. Follow-up care (such as suture removal, fracture care or wound care) should be obtained from your primary care physician or a specialist.
Surgery Services. This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery.
Surgery Services. Abdominoplasty*. • Brow ptosis surgery*, unless medically necessary as indicated in our medical policies. • Cervicoplasty. • Chemical exfoliations, peels, abrasions, dermabrasions, or planing for acne, scarring, wrinkling, sun damage or other benign conditions. • Correction of variations in normal anatomy including augmentation mammoplasty, mastopexy, and correction of congenital breast asymmetry*. • Dermabrasion. • Ear piercing or repair of a torn earlobe. • Excision of excess skin or subcutaneous tissue except for panniculectomy. • Genioplasty*. • Hair transplants. • Hair removal including electrolysis epilation, unless in relation to gender affirming services or skin grafting. • Inverted nipple surgery. • Laser treatment for acne and acne scars. • Osteoplasty - facial bone reduction*. • Otoplasty. • Procedures to correct visual acuity including but not limited to cornea surgery or lens implants. • Removal of asymptomatic benign skin lesions. • Repeated cauterizations or electrofulguration methods used to remove growths on the skin. • Rhinoplasty*. • Rhytidectomy*. • Scar revision, regardless of symptoms. • Sclerotherapy for spider veins. • Skin tag removal. • Subcutaneous injection of filling material*. • Suction assisted Lipectomy*, unless medically necessary as indicated in our medical policies. • Tattooing or tattoo removal except tattooing of the nipple/areola related to a mastectomy. • Treatment of vitiligo. • Standby services of an assistant surgeon or anesthesiologist. • Orthodontic services related to orthognathic surgery. • Cosmetic procedures when performed primarily*: o to refine or reshape body structures or dental structures that are not functionally impaired; o to improve appearance or self-esteem; or o for other psychological, psychiatric or emotional reasons. • Drugs, biological products, hospital charges, pathology, radiology fees and charges for surgeons, assistant surgeons, attending physicians and any other incidental services, which are related to cosmetic surgery. * Services marked with an asterisk may be covered when provided in relation to gender affirming services. See Gender Affirming Services in Section 3 for details.
Surgery Services. For a specialist exam, see Section 3.23 - Office Visits. For diagnostic imaging, lab and machine tests see Section 3.35. See the Summary of Medical Benefits for benefit limits and the amount that you pay for each type of service. If you are admitted to a non-network hospital from the emergency room to receive inpatient services call our Customer Service Department at (000) 000-0000 or 0-000-000-0000 with any questions you have about your coverage. Suture removal, performed where the original emergency services were received, is covered as part of our allowance for the original emergency treatment. We will ONLY cover a separate charge for suture removal if the suturing and suture removal are performed at different locations (i.e. sutures at emergency room and suture removal at doctor’s office).
Surgery Services. Inpatient doctor services 0% - After Deductible 20% - After Deductible Outpatient doctor services 0% - After Deductible 20% - After Deductible In a doctor’s office 0% 20% - After Deductible Telemedicine services When rendered by a designated provider. $20 Not Covered Outpatient/in a doctor’s office/urgent care center or free- standing laboratory: MRI*, MRA*, CAT scans*, CTA scans*, PET scans*, nuclear cardiac imaging* and sleep studies.* 0% - After Deductible 20% - After Deductible Diagnostic imaging and machine tests, other than the diagnostic imaging services listed above. Copayment is per provider per day. 0% 20% - After Deductible Lab and pathology services. 0% 20% - After Deductible See Section 3.0 – Covered Health Care Services for additional benefit limits and coverage information. Diagnostic colorectal services (Including, but not limited to, fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and barium enema. See Prevention and Early Detection Services for preventive colorectal services.) 0% - After Deductible 20% - After Deductible Lyme disease-diagnosis 0% - After Deductible 20% - After Deductible
Surgery Services. Inpatient physician services 0% - After deductible 20% - After deductible Outpatient physician services 0% - After deductible 20% - After deductible In a physician’s office 0% 20% - After deductible When rendered by a designated provider. $15 Not Covered When rendered by a network provider. $15 Not Covered Outpatient, in a physician’s office, urgent care center or free-standing laboratory: MRI*, MRA*, CAT scans*, CTA scans*, PET scans*, and nuclear medicine*. 0% 20% - After deductible Sleep studies.* 0% 20% - After deductible Diagnostic imaging and tests, other than the diagnostic imaging services listed above. 0% 20% - After deductible Lab and pathology services. 0% 20% - After deductible Diagnostic colorectal services - (Including, but not limited to, fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and barium enema. See Prevention and Early Detection Services for preventive colorectal services.) 0% 20% - After deductible Lyme disease diagnosis and treatment 0% 20% - After deductible Urgent care services $25 20% plus $25 - After deductible Vision exam - one routine eye exam per member per plan year. $25 20% plus $25 - After deductible Non-routine eye exam $25 20% plus $25 - After deductible
Surgery Services. Inpatient - doctor services 0% - After Deductible 0% - After Deductible 50% - After Deductible Outpatient - hospital, ambulatory or independent surgical center - doctor services 0% - After Deductible 0% - After Deductible 50% - After Deductible In a doctor’s office - doctor services 0% 0% 50% - After Deductible Telemedicine services - When rendered by a designated provider. $5 $5 Not Covered Outpatient Hospital facility, free standing facilities owned and/ or affiliated with a hospital, or certain designated free standing facilities MRI*, MRA*, CAT scans*, CTA scans*, PET scans*, and nuclear cardiac imaging* Copayment is applied per service. $600 $600 50% - After Deductible Diagnostic imaging and machine tests, other than the diagnostic imaging services listed above. Copayment is per provider per day. $150 $150 50% - After Deductible Lab and pathology services. Copayment is per provider per day. $75 $75 50% - After Deductible Outpatient Hospital facility Sleep Studies $600 $600 50% - After Deductible Outpatient Non-Hospital facility including in a doctor’s office, urgent care center, or free-standing outpatient facility, or other non-hospital setting Sleep Studies $200 $600 50% - After Deductible Outpatient Non-Hospital facilities: including; in a doctor’s office, urgent care center, or certain designated free- standing outpatient facilities MRI*, MRA*, CAT scans*, CTA scans*, PET scans*, and nuclear cardiac imaging* Copayment is applied per service. $200 $600 50% - After Deductible Diagnostic imaging and machine tests, other than the diagnostic imaging services listed above. Copayment is per provider per day. $50 $150 50% - After Deductible Lab and pathology services. Copayment is per provider per day. $25 $75 50% - After Deductible Diagnostic colorectal services (Including, but not limited to, fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and barium enema. See Prevention and Early Detection Services for preventive colorectal services.) 0% - After Deductible 0% - After Deductible 50% - After Deductible Lyme disease-diagnosis 0% - After Deductible 0% - After Deductible 50% - After Deductible
