Prostheses. Internal and external prostheses required to replace a body part are covered. Examples are artificial legs, surgically implanted hip joints, devices to restore speaking after laryngectomy and visual aids (excluding Eyewear) to assist the visually impaired with proper dosing of insulin. Also covered are internally implanted devices such as heart pacemakers. In addition, prostheses to restore symmetry after a Medically Necessary mastectomy are covered. Health Net or your Physician Group will select the provider or vendor for the items. If two or more types of medically appropriate devices or appliances are available, Health Net or the contracting Physician Group will determine which device or appliance will be covered. The device must be among those that the Food and Drug Administration has approved for general use. Prostheses will be replaced when no longer functional. However, repair or replacement for loss or misuse is not covered. Health Net will decide whether to replace or repair an item. You have the right to request a second opinion when: • Your Primary Care Physician or a referral Physician gives a diagnosis or recommends a treatment plan, that you are not satisfied with; • You are not satisfied with the result of treatment you have received; • You are diagnosed with, or a treatment plan is recommended for, a condition that threatens loss of life, limb or bodily function or a substantial impairment, including but not limited to a Serious Chronic Condi- tion; or • Your Primary Care Physician or a referral Physician is unable to diagnose your condition or test results are conflicting. To request an authorization for a second opinion, contact your Primary Care Physician or Health Net’s Customer Contact Center. Physicians at your Physician Group or Health Net will review your request in accordance with Health Net’s procedures and timelines as stated in the second opinion policy. You may obtain a copy of this policy from Health Net’s Customer Contact Center. All authorized second opinions must be provided by a Physician who has training and expertise in the illness, disease or condition associated with the request.
Appears in 1 contract
Prostheses. Internal and external prostheses required to replace a body part are covered. Examples are artificial legs, surgically implanted hip joints, devices to restore speaking after laryngectomy and visual aids (excluding Eyewear) to assist the visually impaired with proper dosing of insulin. Also covered are internally implanted devices such as heart pacemakers. In addition, prostheses to restore symmetry after a Medically Necessary mastectomy are covered. Health Net or your Physician Group will select the provider or vendor for the items. If two or more types of medically appropriate devices or appliances are available, Health Net or the contracting Physician Group will determine which device or appliance will be covered. The device must be among those that the Food and Drug Administration has approved for general use. Prostheses will be replaced when no longer functional. However, repair or replacement for loss or misuse is not covered. Health Net will decide whether to replace or repair an item. You have the right to request a second opinion when: • Your Primary Care Physician or a referral Physician gives a diagnosis or recommends a treatment plan, that you are not satisfied with; • You are not satisfied with the result of treatment you have received; • You are diagnosed with, or a treatment plan is recommended for, a condition that threatens loss of life, limb or bodily function or a substantial impairment, including but not limited to a Serious Chronic Condi- tion; or • Your Primary Care Physician or a referral Physician is unable to diagnose your condition or test results are conflicting. To request an authorization for a second opinion, contact your Primary Care Physician or Health Net’s Customer Contact Center. Physicians at your Physician Group or Health Net will review your request in accordance with Health Net’s procedures and timelines as stated in the second opinion policy. You may obtain a copy of this policy from Health Net’s Customer Contact Center. All authorized second opinions must be provided by a Physician who has training and expertise in the illness, disease or condition associated with the request.
Appears in 1 contract