Common use of Transplant Benefits Clause in Contracts

Transplant Benefits. Transplant benefits include coverage for donation- related services for a living donor (including a po- tential donor), or a transplant organ bank. Donor services must be directly related to a covered trans- plant and must be prior authorized by Blue Shield. Donation-related services include harvesting of the organ, tissue, or bone marrow and treatment of medical complications for a period of 90 days fol- lowing the evaluation or harvest service. Tissue and Kidney Transplants Benefits are provided for Hospital and profes- sional services provided in connection with human tissue and kidney transplants when the Member is the transplant recipient. Benefits include services incident to obtaining the human transplant material from a living donor or a tissue/organ transplant bank. Special Transplants Benefits are provided for certain procedures, listed below, only if: (1) performed at a Special Trans- plant Facility contracting with Blue Shield to pro- vide the procedure, or in the case of Members ac- cessing this Benefit outside of California, the pro- cedure is performed at a transplant facility desig- nated by Blue Shield, (2) prior authorization is ob- tained, in writing through the Benefits Manage- ment Program and (3) the recipient of the trans- plant is a Subscriber or Dependent. Benefits in- clude services incident to obtaining the human transplant material from a living donor or an organ transplant bank. Failure to obtain prior written authorization and/or failure to have the procedure performed at a con- tracting Special Transplant Facility will result in denial of claims for this Benefit. The following procedures are eligible for coverage under this provision: