Page 62 - Aegion Value Plan SPDs
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Durable medical equipment - The rental (or, at the Plan's option, the purchase) of durable medical
equipment prescribed by a Physician or other Provider. Durable medical equipment is equipment which
can withstand repeated use; i.e., could normally be rented, and used by successive patients; is primarily
and customarily used to serve a medical purpose; generally is not useful to a person in the absence of
illness or injury; and is appropriate for use in a patient's home. Examples include but are not limited to
wheelchairs, crutches, hospital beds, oxygen equipment. Rental costs must not be more than the
purchase price. Repair of medical equipment is covered. Non-covered items include but are not
limited to air conditioners, humidifiers, dehumidifiers, special lighting or other environmental modifiers,
surgical supports, and corsets or other articles of clothing.
Prosthetic appliances – Artificial substitutes for body parts and tissues and materials inserted into
tissue for functional or therapeutic purposes. Covered Services include purchase, fitting, needed
adjustment, repairs, and replacements of prosthetic devices and supplies that:
1. Replace all or part of a missing body part and its adjoining tissues; or
2. Replace all or part of the function of a permanently useless or malfunctioning body part.
Covered Services for prosthetic appliances include, but are not limited to:
1. Aids and supports for defective parts of the body including but not limited to internal heart valves,
mitral valve, internal pacemaker, pacemaker power sources, synthetic or homograph vascular
replacements, fracture fixation devices internal to the body surface, replacements for injured or
diseased bone and joint substances, mandibular reconstruction appliances, bone screws, plates,
and vitallium heads for joint reconstruction;
2. Left Ventricular Artificial Devices (LVAD) (only when used as a bridge to a heart transplant);
3. Breast prosthesis whether internal or external, following a mastectomy, and two surgical bras per
Benefit Period or as Medically Necessary, as required by the Women’s Health and Cancer Rights
Act;
4. Minor devices for repair such as screws, nails, sutures and wire mesh;
5. Replacements for all or part of absent parts of the body or extremities, such as artificial limbs,
artificial eyes, etc.;
6. Intraocular lens implantation for the treatment of cataract or aphakia. Contact lenses or glasses
are often prescribed following lens implantation and are Covered Services. (If cataract extraction
is performed, intraocular lenses are usually inserted during the same operative session);
7. Artificial gut systems (parenteral devices necessary for long- term nutrition in cases of severe and
otherwise fatal pathology of the alimentary tract - formulae and supplies are also covered)
8. Cochlear implant;
9. Electronic speech aids in post-laryngectomy or permanently inoperative situations;
10. "Space Shoes" when used as a substitute device when all or a substantial portion of the forefoot is
absent;
11. Wigs (One per benefit period, subject to medical necessity)
Non-covered Prosthetic appliances include but are not limited to:
1. Dentures, replacing teeth or structures directly supporting teeth; (may be covered by Your dental
plan)
2. Dental appliances; (may be covered by Your dental plan)
3. Such non-rigid appliances as elastic stockings, garter belts, arch supports and corsets;
4. Artificial heart implants;
5. Hairpieces for male pattern alopecia (baldness);
6. Wigs (except as described above).
Orthotic devices – Covered Services are the initial purchase, fitting, and repair of a custom made rigid or
semi-rigid supportive device used to support, align, prevent, or correct deformities or to improve the function
of movable parts of the body, or which limits or stops motion of a weak or diseased body part. The cost of
casting, molding, fittings, and adjustments are included.
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equipment prescribed by a Physician or other Provider. Durable medical equipment is equipment which
can withstand repeated use; i.e., could normally be rented, and used by successive patients; is primarily
and customarily used to serve a medical purpose; generally is not useful to a person in the absence of
illness or injury; and is appropriate for use in a patient's home. Examples include but are not limited to
wheelchairs, crutches, hospital beds, oxygen equipment. Rental costs must not be more than the
purchase price. Repair of medical equipment is covered. Non-covered items include but are not
limited to air conditioners, humidifiers, dehumidifiers, special lighting or other environmental modifiers,
surgical supports, and corsets or other articles of clothing.
Prosthetic appliances – Artificial substitutes for body parts and tissues and materials inserted into
tissue for functional or therapeutic purposes. Covered Services include purchase, fitting, needed
adjustment, repairs, and replacements of prosthetic devices and supplies that:
1. Replace all or part of a missing body part and its adjoining tissues; or
2. Replace all or part of the function of a permanently useless or malfunctioning body part.
Covered Services for prosthetic appliances include, but are not limited to:
1. Aids and supports for defective parts of the body including but not limited to internal heart valves,
mitral valve, internal pacemaker, pacemaker power sources, synthetic or homograph vascular
replacements, fracture fixation devices internal to the body surface, replacements for injured or
diseased bone and joint substances, mandibular reconstruction appliances, bone screws, plates,
and vitallium heads for joint reconstruction;
2. Left Ventricular Artificial Devices (LVAD) (only when used as a bridge to a heart transplant);
3. Breast prosthesis whether internal or external, following a mastectomy, and two surgical bras per
Benefit Period or as Medically Necessary, as required by the Women’s Health and Cancer Rights
Act;
4. Minor devices for repair such as screws, nails, sutures and wire mesh;
5. Replacements for all or part of absent parts of the body or extremities, such as artificial limbs,
artificial eyes, etc.;
6. Intraocular lens implantation for the treatment of cataract or aphakia. Contact lenses or glasses
are often prescribed following lens implantation and are Covered Services. (If cataract extraction
is performed, intraocular lenses are usually inserted during the same operative session);
7. Artificial gut systems (parenteral devices necessary for long- term nutrition in cases of severe and
otherwise fatal pathology of the alimentary tract - formulae and supplies are also covered)
8. Cochlear implant;
9. Electronic speech aids in post-laryngectomy or permanently inoperative situations;
10. "Space Shoes" when used as a substitute device when all or a substantial portion of the forefoot is
absent;
11. Wigs (One per benefit period, subject to medical necessity)
Non-covered Prosthetic appliances include but are not limited to:
1. Dentures, replacing teeth or structures directly supporting teeth; (may be covered by Your dental
plan)
2. Dental appliances; (may be covered by Your dental plan)
3. Such non-rigid appliances as elastic stockings, garter belts, arch supports and corsets;
4. Artificial heart implants;
5. Hairpieces for male pattern alopecia (baldness);
6. Wigs (except as described above).
Orthotic devices – Covered Services are the initial purchase, fitting, and repair of a custom made rigid or
semi-rigid supportive device used to support, align, prevent, or correct deformities or to improve the function
of movable parts of the body, or which limits or stops motion of a weak or diseased body part. The cost of
casting, molding, fittings, and adjustments are included.
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