Biofeedback. Biofeedback is only Covered for treatment of Raynaud’s disease or phenomenon and urinary or fecal incontinence. COVID-19 As a Presbyterian Health Plan Member, there will be no cost to you for anything related to COVID-19 screening, testing, medical treatment, or vaccination, including boosters. You will not pay copays, deductibles or coinsurance for visits related to COVID-19, whether at a clinic, hospital or using remote care. If you are on a high deductible plan (HDHP), these services will also be provided to you at no cost. Dental Services (Limited) This benefit has one or more exclusions as specified in the Exclusions Section. Dental benefits will be provided in connection with the following conditions when deemed Medically Necessary except in an emergency situation as described in the Accidental Injury (trauma), Urgent Care, Emergency Healthcare Services and Observation Services Section. Covered Services are as follows: · Accidental Injury to sound natural teeth, jawbones or surrounding tissue. Dental injury caused by chewing, biting, or Malocclusion is not considered an Accidental Injury and will not be Covered. · The correction of non-dental physiological conditions such as, but not limited to, cleft palate repair that has resulted in a severe functional impairment. · The treatment for tumors and cysts requiring pathological examination of the jaws, cheeks, lips, tongue, roof and floor of the mouth. · Hospitalization, day surgery, Outpatient and/or anesthesia for non- Covered dental services, are Covered, if provided in a Hospital or ambulatory surgical center for dental surgery, with our approval of a Prior Authorization request. Plan benefits for these services include coverage: o For Members who exhibit physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities cannot be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce superior results. o For Members for whom local anesthesia is ineffective because of acute infection, anatomic variation or allergy. o For Covered Dependent children or adolescents who are extremely uncooperative, fearful, anxious, or uncommunicative with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or o...
Biofeedback. 14. Medically necessary health care services, including equipment and supplies, that are prescribed by your provider for the management and treatment of type I diabetes, type II diabetes, and/or gestational diabetes.
Biofeedback. Biofeedback is only Covered for treatment of Raynaud’s disease or phenomenon and urinary or fecal incontinence. COVID-19 As a Presbyterian Health Plan member, there will be no cost to you for anything related to COVID-19 screening, testing, medical treatment, or vaccinations. You will not pay copays, deductibles or coinsurance for visits related to COVID-19, whether at a clinic, hospital or using remote care. If you are on a high deductible plan (HDHP), these services will also be provided to you at no cost. Presbyterian Vision Benefit As an Individual Plan Member, you are eligible for Presbyterian Vision Benefits. These benefits include preventive vision care as part of your enrollment in a Presbyterian Individual Plan. Please see the Presbyterian vision flyers attached to the end of this Subscriber Agreement. Dental Services (Limited) This benefit has one or more exclusions as specified in the Exclusions Section. Dental benefits will be provided in connection with the following conditions when deemed Medically Necessary except in an emergency situation as described in the Accidental Injury (trauma), Urgent Care, Emergency Healthcare Services and Observation Services Section. Covered Services are as follows: • Accidental Injury to sound natural teeth, jawbones or surrounding tissue. Dental injury caused by chewing, biting, or Malocclusion is not considered an Accidental Injury and will not be Covered. • The correction of non-dental physiological conditions such as, but not limited to, cleft palate repair that has resulted in a severe functional impairment. • The treatment for tumors and cysts requiring pathological examination of the jaws, cheeks, lips, tongue, roof and floor of the mouth. • Hospitalization, day surgery, Outpatient and/or anesthesia for non- Covered dental services, are Covered, if provided in a Hospital or ambulatory surgical center for dental surgery, with our approval of a Prior Authorization request. Plan benefits for these services include coverage: o For Members who exhibit physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities cannot be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce superior results. o For Members for whom local anesthesia is ineffective because of acute infection, anatomic variation or allergy. o For Covered Dependent chi...
Biofeedback. 26. For any claim submitted by non lock-in pharmacy while member is in lock-in status. To facilitate appropriate benefit use and prevent opioid overutilization, member's participation in lock-in status will be determined by review of pharmacy claims.
Biofeedback. 9. Upper and lower jawbone surgery, orthognathic surgery, and jaw alignment. This exclusion does not apply to reconstructive jaw surgery required for you because of a Congenital Anomaly, acute traumatic Injury, dislocation, tumors, cancer or obstructive sleep apnea. This exclusion does not apply to reduction of a dislocation or fracture of the jaw or facial bone; excision of a benign or malignant tumor of the jaw; and orthognathic surgery that you need to correct a significant functional impairment that cannot be adequately corrected with orthodontic services. You must have a serious medical condition that requires that you be admitted to a Hospital as an inpatient in order for the surgery to be safely performed.
Biofeedback. Biofeedback is only Covered for treatment of Raynaud’s disease or phenomenon and urinary or fecal incontinence. COVID-19 As a Presbyterian Insurance Company member, there will be no cost to you for anything related to COVID-19 screening, testing or medical treatment. You will not pay Copays, Deductibles or Coinsurance for visits related to COVID-19, whether at a clinic, Hospital or using remote care. If you are on a high deductible plan (HDHP), these services will also be provided to you at no cost.
Biofeedback. 13. Telemedicine services may include interactive audio and video communications, permitting real time communication between a distant site provider of health care services and the member, who is present and participating in the televideo visit at a remote provider office.
Biofeedback. 9. Services for the evaluation and treatment of temporomandibular joint syndrome (TMJ), whether the services are considered to be medical or dental in nature.
Biofeedback. Coverage for biofeedback therapy is limited to Medically Necessary treatment of certain physical disorders such as incontinence and chronic Pain, and as otherwise preauthorized by Behavioral Health Administrator. Blood Blood transfusions, including blood processing, the cost of blood, unreplaced blood and blood products, are covered. Self-donated (autologous) blood transfusions are covered only for a surgery that the contracting Physician Group has authorized and scheduled. This Plan does not cover treatments which use umbilical cord blood, cord blood stem cells or adult stem cells (nor their collection, preservation and storage) as such treatments are considered to be Experimental or Investigational in nature. See the "General Provisions" section for the procedure to request an Independent Medical Review of a Plan denial of coverage on the basis that it is considered Experimental or Investigation- al. Exclusions and Limitations Page 73 Clinical Trials Although routine patient care costs for clinical trials are covered, as described in the "Medical Services and Supplies" portion of the "Covered Services and Supplies" section, coverage for clinical trials does not include the following items: Drugs or devices that are not approved by the FDA; Services other than Health Care Services, including but not limited to cost of travel or costs of other non- clinical expenses; Services provided to satisfy data collection and analysis needs which are not used for clinical management; Health Care Services that are specifically excluded from coverage under this Evidence of Coverage; and Items and services provided free of charge by the research sponsors to Members in the trial. Conception by Medical Procedures Artificial insemination is covered when a female Member and/or her male partner is infertile (refer to Infertility in the "Definitions" section). However, if only the male partner is a Member and the female partner (who is not a Member) is infertile, artificial insemination will not be covered. The collection, storage or purchase of sperm is not covered. Other services or supplies that are intended to impregnate a woman are not covered. Excluded procedures include, but are not limited to: In-vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT) or any process that involves harvesting, transplanting or manipulating a human ovum. Also not covered are services or supplies (including injections and injectable medicati...
Biofeedback. 8. The following services for the diagnosis and treatment of Temporomandibular Joint Syndrome (TMJ): surface electromyography; Doppler analysis; vibration analysis; computerized mandibular scan or jaw tracking; craniosacral therapy; orthodontics; occlusal adjustment; and dental restorations.
