Page 50 - APPENDICES for Stephen Spero
P. 50
Opioid treatment program services
In-network: $20 copay
Limits apply
OTHER SERVICES
Durable medical equipment (like wheelchairs & oxygen)
$0 copay or 20% coinsurance per item
Limits apply
Prosthetics (like braces, arti cial limbs)
20% coinsurance per item
Limits apply
Diabetes supplies
$0 copay
Limits apply
Extra bene ts & costs
HEARING
Hearing exam
$35 copay
Limits apply
Fitting/evaluation
$0 copay
Limits apply
Hearing aids - All types
$0 copay
Limits apply
