Common use of Benefit Limits Clause in Contracts

Benefit Limits. Benefits are limited to the least expensive Medically Necessary Durable Medical Equipment, Medical Supply, Orthotic Device or Prosthetic adequate to meet the patient’s medical needs. Purchase or rental of any Medical Device is at the discretion of CareFirst BlueChoice. Benefits will be limited to the lower cost of purchase or rental, taking into account the length of time the Member requires, or is reasonably expected to require the equipment, and the durability of the equipment, etc. The purchase price or rental cost must be the least expensive of its type adequate to meet the medical needs of the Member. If the Member selects a deluxe version of the appliance, device, or equipment not determined by CareFirst BlueChoice to be Medically Necessary, CareFirst BlueChoice will pay an amount that does not exceed CareFirst’s payment for the basic device (minus any Member Copayment or Coinsurance) and the Member will be fully responsible for paying the remaining balance.