Page 65 - Aegion PPO SPDs
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psychologist. The goal is to obtain practical improvement in a reasonable length of time in the appropriate
setting.
Physical medicine and rehabilitation involves several types of therapy, not just physical therapy, and a
coordinated team approach. The variety and intensity of treatments required is the major differentiation
from an admission primarily for physical therapy.
Home Care Services
Services performed by a Home Health Care Agency or other Provider in Your residence. The services
must be provided on a part-time visiting basis according to a course of treatment. Covered Services include
but are not limited to:
Intermittent Skilled Nursing Services (by an R.N. or L.P.N.);
diagnostic Services;
Medical/Social Services;
Nutritional Guidance;
Home Health Aide Services;
Therapy Services
Medical/Surgical Supplies;
Durable Medical Equipment;
Prescription Drugs (only if provided and billed by a Home Health Care Agency);
Private Duty Nursing.
Home infusion therapy will be paid only if You obtain prior approval from the Claims Administrator.
Benefits for home infusion therapy include a combination of nursing, durable medical equipment and
pharmaceutical services which are delivered and administered intravenously in the home. Home IV therapy
includes but is not limited to: injections (intra-muscular, subcutaneous, and continuous subcutaneous),
Total Parenteral Nutrition (TPN), Enteral nutrition therapy, Antibiotic therapy, pain management and
chemotherapy.
Habilitative Services
Benefits also include habilitative health care services and devices that help You keep, learn or improve
skills and functioning for daily living. Examples include therapy for a child who isn’t walking or talking at the
expected age. These services may include physical and occupational therapy, speech-language pathology
and other services for people with disabilities in a variety of Inpatient and/or outpatient settings.
Hospice Services
You are eligible for hospice care if Your Doctor and the Hospice medical director certify that You are
terminally ill and likely to have less than twelve (12) months to live. You may access hospice care while
participating in a clinical trial or continuing disease modifying therapy, as ordered by Your treating Provider.
Disease modifying therapy treats the underlying terminal illness.
The services and supplies listed below are Covered Services when given by a Hospice for the palliative
care of pain and other symptoms that are part of a terminal disease. Palliative care means care that controls
pain and relieves symptoms, but is not meant to cure a terminal illness. Covered Services include:
Care from an interdisciplinary team with the development and maintenance of an appropriate plan of
care.
Short-term Inpatient Hospital care when needed in periods of crisis or as respite care.
Skilled nursing services, home health aide services, and homemaker services given by or under the
supervision of a registered nurse.
Social services and counseling services from a licensed social worker.
Nutritional support such as intravenous feeding and feeding tubes.
65
setting.
Physical medicine and rehabilitation involves several types of therapy, not just physical therapy, and a
coordinated team approach. The variety and intensity of treatments required is the major differentiation
from an admission primarily for physical therapy.
Home Care Services
Services performed by a Home Health Care Agency or other Provider in Your residence. The services
must be provided on a part-time visiting basis according to a course of treatment. Covered Services include
but are not limited to:
Intermittent Skilled Nursing Services (by an R.N. or L.P.N.);
diagnostic Services;
Medical/Social Services;
Nutritional Guidance;
Home Health Aide Services;
Therapy Services
Medical/Surgical Supplies;
Durable Medical Equipment;
Prescription Drugs (only if provided and billed by a Home Health Care Agency);
Private Duty Nursing.
Home infusion therapy will be paid only if You obtain prior approval from the Claims Administrator.
Benefits for home infusion therapy include a combination of nursing, durable medical equipment and
pharmaceutical services which are delivered and administered intravenously in the home. Home IV therapy
includes but is not limited to: injections (intra-muscular, subcutaneous, and continuous subcutaneous),
Total Parenteral Nutrition (TPN), Enteral nutrition therapy, Antibiotic therapy, pain management and
chemotherapy.
Habilitative Services
Benefits also include habilitative health care services and devices that help You keep, learn or improve
skills and functioning for daily living. Examples include therapy for a child who isn’t walking or talking at the
expected age. These services may include physical and occupational therapy, speech-language pathology
and other services for people with disabilities in a variety of Inpatient and/or outpatient settings.
Hospice Services
You are eligible for hospice care if Your Doctor and the Hospice medical director certify that You are
terminally ill and likely to have less than twelve (12) months to live. You may access hospice care while
participating in a clinical trial or continuing disease modifying therapy, as ordered by Your treating Provider.
Disease modifying therapy treats the underlying terminal illness.
The services and supplies listed below are Covered Services when given by a Hospice for the palliative
care of pain and other symptoms that are part of a terminal disease. Palliative care means care that controls
pain and relieves symptoms, but is not meant to cure a terminal illness. Covered Services include:
Care from an interdisciplinary team with the development and maintenance of an appropriate plan of
care.
Short-term Inpatient Hospital care when needed in periods of crisis or as respite care.
Skilled nursing services, home health aide services, and homemaker services given by or under the
supervision of a registered nurse.
Social services and counseling services from a licensed social worker.
Nutritional support such as intravenous feeding and feeding tubes.
65
