Orthotics. Orthotic devices means rigid or semi-rigid supportive devices that restrict or eliminate motion of a weak or diseased body part. Orthotic braces such as for the leg, arm, neck and back, including needed changes to shoes to fit braces, braces that stabilize an injured body part and braces to treat curvature of the spine are a Covered Health Care Service. Coverage will be provided for the training necessary to use the orthotic device. Benefits are available for fitting, repairs and replacement, except as described in Section 2: Exclusions and Limitations.
Orthotics. Pre-fabricated Orthotics requires Prior Authorization. Outpatient Medical Services This benefit has one or more exclusions as specified in the Exclusions Section. Outpatient Medical Services are services provided in a Hospital, outpatient facility, Practitioner’s/Provider’s office or other appropriately licensed facility. These services do not require admission to any facility. Outpatient Medical services include reasonable Hospital services provided on an ambulatory (outpatient) basis and those preventive, Medically Necessary diagnostic and treatment procedures that are prescribed by your In-network Practitioner/Provider. Refer to the Prior Authorization Section for services that require Prior Authorization. Outpatient services provided by Out-of-network Providers/Practitioners are not Covered except as provided in How the Plan Works, Eligibility and Enrollment, and Accidental Injury / Urgent Care / Emergency Health Services / Observation / Trauma Services Benefit Sections. Outpatient Medical benefits include, but are not limited to, the following services: • Chemotherapy and radiation therapy - Chemotherapy is the use of chemical agents in the treatment or control of disease. • Hypnotherapy (Limited) - Hypnotherapy is only Covered when performed by an anesthesiologist or psychiatrist, trained in the use of hypnosis when: Used within two weeks prior to surgery for chronic pain management and For chronic pain management when part of a coordinated treatment plan. • Dialysis • Diagnostic Services – Refer to the Diagnostic Services Section • Medical Drugs (Medications obtained through the medical benefit).
Orthotics. To the extent described in Section SC - Schedule of Cost Sharing, Benefits include participation in a diabetes outpatient self-management training and education program under the supervision of a licensed health care professional with expertise in diabetes. Coverage for self-management education and education relating to diet and prescribed by a licensed Physician shall include:
Orthotics. Some Pre-fabricated Orthotics require Prior Authorization.
Orthotics. Coverage for prescribed orthotics will be established with a maximum limit of two hundred dollars ($200) per member or dependent per calendar year.
Orthotics. This Service Plan does not cover supportive devices for the foot, including, but not limited to, foot inserts, arch supports, heel pads and heel cups, and orthopedic/corrective shoes.
Orthotics. A. Ankle–Foot Orthosis (AFO) and Knee–Ankle–Foot Orthosis (KAFO).
Orthotics o. Treatments or diagnosis for obesity, including diet control, exercise and weight reductions, except for morbid obesity. This exclusion does not apply to any obesity or disease management program agreed to by the parties.
Orthotics. 15. Treatments or diagnosis for obesity, including diet control, exercise and weight reductions, except for morbid obesity.
