Transplant Facility definition

Transplant Facility means a Hospital that has an independent contractor agreement or other contractual relationship with the CO-OP to provide Covered Services related to a Covered Transplant Procedure as defined in this EOC. Non-Plan Hospitals do not have agreements with the CO-OP to provide such services.

Transplant Facility means a Hospital that has an independent contractor agreement or other contractual relationship with HPN to provide Covered Services related to a Covered Transplant Procedure as defined in this EOC. Non-Plan Hospitals do not have agreements with HPN to provide such services.

Transplant Facility means a Hospital that has an independent contractor agreement or other contractual relationship with SHL to provide Covered Services related to a Covered Transplant Procedure as defined in this Certificate. Non-Plan Hospitals do not have agreements with SHL to provide such services.

Examples of Transplant Facility in a sentence

• Travel expenses, limited to a maximum lifetime benefit of $10,000 for organ transplants performed at a Special Transplant Facility, or $5,000 for organ transplants performed at other facilities.

• The cost of a donor search, limited to a maximum benefit of $15,000 per organ transplant when the search is conducted by a Special Transplant Facility or $5,000 per organ transplant when the search is conducted by other facilities.

• Benefits also include services incident to obtaining the human transplant mate- rial from a living donor or a tissue/organ transplant bank.Special TransplantBenefits are provided for certain procedures, listed below, only if (1) performed at a Special Transplant Facility contracting with Blue Shield to provide the procedure, (2) prior authorization is ob- tained, in writing from Blue Shield and (3) the re- cipient of the transplant is a Subscriber or Depen- dent.

• Covered Services for patient selection criteria shall be covered at one (1) Designated Transplant Facility.

• Failure to obtain prior written authorization and/or failure to have the procedure performed at a contracting Special Transplant Facility will result in denial of claims for this Benefit.

• 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.

• If the second Designated Transplant Facility also determines the Member is not eligible for the transplant procedure, no coverage will be provided for further transplant-related services.

• Benefits will be different for services provided at a Designated Transplant Facility than services provided at a Non-designated Transplant Facility.

• A Board Certified Specialist must be utilized for this second opinion.A person who will be undergoing a transplant procedure will be referred to a Designated Transplant Facility.

• This referral and authorization for services at a Designated Transplant Facility shall continue to be appropriate through the Transplant Benefit Period.If the Covered Person is denied the procedure by the Designated Transplant Facility, he/she may be referred to a second such facility for evaluation.

More Definitions of Transplant Facility

Transplant Facility means a Hospital that has an independent contractor agreement or other contractual relationship with HPN to provide Covered Services to Eligible Members in connection with organ or tissue transplants related to a Covered Transplant Procedure as defined in this AOC. Non-Plan Hospitals do not have any contractual relationship with HPN to provide such services.

Transplant Facility means a Hospital that has an independent contractor agreement or other contractual relationship with SHL to provide Covered Services related to a Covered Transplant Procedure as defined in this AOC. Non-Plan Hospitals do not have agreements with SHL to provide such services.

Transplant Facility means a Hospital that has an independent contractor agreement or other contractual relationship with HPN to provide Covered Services to Eligible Members in connection with organ or tissue transplants related to a Covered Transplant Procedure as defined in this AOC. Non-Plan Hospitals do not have any contractual relationship with HPN to provide such services. ❖ “Unproven” in the context of “Experimental, Investigational or Unproven”, means services, including medications, that are not determined to be effective for treatment of the medical condition or not determined to have a beneficial effect on health outcomes due to insufficient and inadequate clinical evidence from well-conducted randomized controlled trials or cohort studies in the prevailing published peer-reviewed medical literature. • Well-conducted randomized controlled trials. (Two or more treatments are compared to each other, and the patient is not allowed to choose which treatment is received.) • Well-conducted cohort studies from more than one institution. (Patients who receive study treatment are compared to a group of patients who receive standard therapy. The comparison group must be nearly identical to the study treatment group.)

Transplant Facility means a Hospital that has an independent contractor agreement or other contractual relationship with SHL to provide Covered Services related to a Covered Transplant Procedure as defined in this AOC. Non-Plan Hospitals do not have agreements with SHL to provide such services.  “Unproven” in the context of “Experimental, Investigational or Unproven”, means services, including medications, that are not determined to be effective for treatment of the medical condition or not determined to have a beneficial effect on health outcomes due to insufficient and inadequate clinical evidence from well-conducted randomized controlled trials or cohort studies in the prevailing published peer-reviewed medical literature.  Well-conducted randomized controlled trials. (Two or more treatments are compared to each other, and the patient is not allowed to choose which treatment is received.)  Well-conducted cohort studies from more than one institution. (Patients who receive study treatment are compared to a group of patients who receive standard therapy. The comparison group must be nearly identical to the study treatment group.) SHL has a process by which we compile and review clinical evidence with respect to certain health care services. From time to time, SHL will issue medical and drug policies that describe the clinical evidence available with respect to specific health care services. These medical and drug policies are subject to change without prior notice. The Insured can view these policies at xxxxx://xxxxxxxxxxxxxxxxxx.xxx/Provider/Medical-Policies NOTE: If the Insured has a life-threatening illness or condition (one that is likely to cause death within one year of the request for treatment) SHL may, as we determine, consider an otherwise unproven service to be a covered healthcare service for that illness or condition. Prior to such a consideration, SHL must first establish that there is sufficient evidence to conclude that, even though Unproven, the service has significant potential as an effective treatment for that illness or condition.

Transplant Facility means an COE (Center of Excellence) or EPO (Exclusive Provider Organization) network of credentialed and volume monitored transplant professionals and facilities that has an independent contractor agreement or other contractual relationship with the CO-OP to provide Covered Services related to a Covered Transplant Procedure as defined in this EOC.