Transplant Services. Expenses for the following are excluded:
Transplant Services. Transplant services are limited to AvMed’s In-Network Center of Excellence facilities located within the State of Florida. Transportation costs for a companion to accompany the Member (or two companions when the patient is a minor) are covered only if the Member has to travel greater than a 50-mile radius to receive the transplant, and are limited to $200 per day up to a $10,000 lifetime maximum.
Transplant Services. Benefits are available for tissue and kidney transplants and special transplants. Tissue and kidney transplants Benefits are available for facility and professional services provided in connection with human tissue and kidney transplants when you are 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 available for special transplants only if: • The procedure is performed at a special transplant facility contracting with Blue Shield, or if you access this Benefit outside of California, the procedure is performed at a transplant facility designated by Blue Shield; and • You are the recipient of the transplant. Special transplants are: • Human heart transplants; • Human lung transplants; • Human heart and lung transplants in combination; • Human liver transplants; • Human kidney and pancreas transplants in combination; • Human bone marrow transplants, including autologous bone marrow transplantation (ABMT) or autologous peripheral stem cell transplantation used to support high-dose chemotherapy when such treatment is Medically Necessary and is not Experimental or Investigational; • Pediatric human small bowel transplants; and • Pediatric and adult human small bowel and liver transplants in combination.
Transplant Services. Eligibility for Covered Services related to human organ, bone and tissue transplant are as follows. When the Member is the recipient of transplanted human organs, marrow, or tissues, benefits are provided for all Covered Services. Covered Services for Inpatient and Outpatient Care related to the transplant include procedures which are generally accepted as not Experimental/Investigational Services by medical organizations of national reputation. These organizations are recognized by the HMO as having special expertise in the area of medical practice involving transplant procedures. Benefits are also provided for those services which are directly and specifically related to the Member’s covered transplant. This includes services for the examination of such transplanted organs, marrow, or tissue and the processing of blood provided to the Member. The determination of Medical Necessity for transplants will take into account the proposed procedure's suitability for the potential recipient and the availability of an appropriate facility for performing the procedure. Eligibility for Covered Services related to human organ, bone and tissue transplant are as follows. If a human organ or tissue transplant is provided from a donor to a human transplant recipient:
Transplant Services. Subject to the provisions of this Agreement, benefits will be provided for Covered Services furnished by a Hospital which are directly and specifically related to transplantation of organs, bones, tissue or blood stem cells. If a human organ, bone, tissue or blood stem cell transplant is provided from a living donor to a human transplant recipient:
Transplant Services. Provision of transplant services is limited to Center of Excellence facilities located within the State of Florida, with whom XxXxx has contracted to provide transplant services as described in this Contract. Transportation costs for a companion to accompany the Member (or two companions when the patient is a minor) are covered only if the Member has to travel greater than a 50-mile radius to receive the transplant, and are limited to $200 per day up to a $10,000 lifetime maximum.
Transplant Services. For those transplant Professional Capitation Services, including without limitation, bone marrow/stem cell and solid organ for which PARTICIPATING MEDICAL GROUP is financially responsible (ie, professional component), PARTICIPATING MEDICAL GROUP shall pay for such services at the applicable rate negotiated by BLUE CROSS for professional transplant services or at the rate negotiated by PARTICIPATING MEDICAL GROUP. If such payment has been made by BLUE CROSS, PARTICIPATING MEDICAL GROUP shall remit payment to BLUE CROSS within forty-five (45) days of BLUE CROSS written request or BLUE CROSS may adjust subsequent Capitation payments to offset such payment amount.
Transplant Services. The benefit package includes transplantation services. The following transplants are covered in the benefit package: heart transplants, lung transplants, heart-lung transplants, liver transplants, kidney transplants, autologous bone marrow transplants, allegoric bone marrow transplants and corneal transplants, as detailed in MAD Program Manual Section MAD-764, TRANSPLANT SERVICES, Section MAD-765, EXPERIMENTAL OR INVESTIGATIONAL PROCEDURES, TECHNOLOGIES, OR NON-DRUG THERAPIES.
Transplant Services. If the following criteria are met, we cover stem cell rescue and transplants of organs, tissue, or bone marrow: • You satisfy all medical criteria developed by Medical Group and by the facility providing the transplant; • The facility is certified by Medicare; and • A Plan Provider provides a written referral for care at the facility. After the referral to a transplant facility, the following applies: • Unless otherwise authorized by Medical Group, transplants are covered only in our Service Area. • If either Medical Group or the referral facility determines that you do not satisfy its respective criteria for transplant, we will pay only for covered Services you receive before that determination was made. • Health Plan, Plan Hospitals, Medical Group and Plan Providers are not responsible for finding, furnishing, or ensuring the availability of a bone marrow or organ donor. • We cover reasonable medical and hospital expenses as long as these expenses are directly related to a covered transplant for a donor, or an individual identified by Medical Group as a potential donor even if not a Member. Transplant Services Exclusions: • Services related to non-human or artificial organs and their implantation. GG. Urgent Care As described below you are covered for Urgent Care Services anywhere in the world. “Urgent Care Services” are defined as Services required as the result of a sudden illness or injury, which requires prompt attention, but is not of an emergent nature.” Your Copayment or Coinsurance will be determined by the place of Service (i.e., at a Provider’s office or at an after hours urgent care center, as shown in the Summary of Services and Cost Shares section. Inside our Service Area We will cover reasonable charges for Urgent Care Services received from Plan Providers and Plan Facilities within the Service Area. If you require Urgent Care Services please call your primary care Plan Provider as follows: If your primary care Plan Physician is located at a Plan Medical Office please call: Inside the Washington, D.C. Metropolitan Area (000) 000-0000 TTY (000) 000-0000 Outside the Washington, D.C. Metropolitan Area 0-000-000-0000 TTY 0-000-000-0000 If your primary care Plan Physician is located in our network of Plan Providers, please call his or her office directly. You will find his or her telephone number on the front of your identification card. Outside our Service Area If you are injured or become ill while temporarily outside the Service Area, we will...
Transplant Services. Transplant Services, limited to the procedures listed below, are covered when performed at a facility acceptable to us, subject to the conditions and limitations described below. Transplant includes pre-transplant, transplant and post-discharge Services and treatment of any complications after transplantation.
