2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
Page 66
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
Page 66
Benefit Description
Organ/Tissue Transplants
The following transplants must be performed at a Blue Distinction Centers for Transplants (see page 17 for more information):
Note: For covered related transplant services, see pages 66 and 67.
You Pay
When performed in a Blue Distinction Centers for Transplants: 30% of the Plan allowance (deductible applies)
All other providers (Participating/Non-participating): You pay all charges
Note: Your provider will document the place of service when filing your claim for the procedure(s). Please contact the provider if you have any questions about the place of the service.
Organ/Tissue Transplants
The following transplants must be performed at a Blue Distinction Centers for Transplants (see page 17 for more information):
- Blood or marrow stem cell transplants (adult and pediatric) listed on pages 63-64
- Heart transplant (adult and pediatric)
- Implantation of an artificial heart as a bridge to transplant or destination therapy (when performed in a Blue Distinction Center for Heart Transplants)
- Implantation of an artificial heart as a bridge to transplant or destination therapy (when performed in a Blue Distinction Center for Heart Transplants)
- Liver transplant (adult and pediatric)
- Lung:
- For members with end-stage cystic fibrosis, benefits for lung transplantation are limited to double lung transplants
- For members with end-stage cystic fibrosis, benefits for lung transplantation are limited to double lung transplants
- Combination liver-kidney transplant
- Single, double, or lobar lung transplant (adult)
Note: For covered related transplant services, see pages 66 and 67.
You Pay
When performed in a Blue Distinction Centers for Transplants: 30% of the Plan allowance (deductible applies)
All other providers (Participating/Non-participating): You pay all charges
Note: Your provider will document the place of service when filing your claim for the procedure(s). Please contact the provider if you have any questions about the place of the service.
Benefit Description
The following transplants are not available in a Blue Distinction Centers for Transplants® and must be performed at a Preferred facility with a Medicare-Approved transplant program, if one is available (see below):
Notes:
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Note: Your provider will document the place of service when filing your claim for the procedure(s). Please contact the provider if you have any questions about the place of the service.
The following transplants are not available in a Blue Distinction Centers for Transplants® and must be performed at a Preferred facility with a Medicare-Approved transplant program, if one is available (see below):
- Autologous pancreas islet cell transplant (as an adjunct to total or near total pancreatectomy) only for patients with chronic pancreatitis
- Corneal tissue transplant
- Heart-lung transplant
- Intestinal transplants (small intestine) and the small intestine with the liver or small intestine with multiple organs such as the liver, stomach, and pancreas
- Kidney transplant
- Pancreas transplant
- Combination liver-kidney transplant (pediatric)
- Combination pancreas-kidney transplant
- Single, double, or lobar lung transplant (pediatric)
Notes:
- Organ transplants that are not available in a Blue Distinction Center for Transplants must be performed in a facility with a Medicare-Approved Transplant Program for the type of transplant anticipated. Transplants involving more than one organ must be performed in a facility that offers a Medicare-Approved Transplant Program for each organ transplanted. Contact your local Plan for Medicare’s approved transplant programs.
- If Medicare does not offer an approved program for a certain type of organ transplant procedure, this requirement does not apply and you may use any Preferred facility that performs the procedure. If Medicare offers an approved program for an anticipated organ transplant, but your facility is not approved by Medicare for the procedure, please contact your Local Plan at the customer service phone number appearing on the back of your ID card.
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Note: Your provider will document the place of service when filing your claim for the procedure(s). Please contact the provider if you have any questions about the place of the service.
Organ/Tissue Transplants - continued on next page