These rules determine the order in which the plans will pay benefits. endobj 7500 Rialto Blvd, Building 1 Suite 250 What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. Please note: If you are covered under the State of Delaware Group Health Insurance Plan as secondary, refer to the SurgeryPlus plan document for details on bariatric coverage. A prime example is breast implants done during or after breast cancer surgery. You can make monthly payments by monthly bank draft (ACH) or pay for the entire year via credit card payment. 0000401803 00000 n The cost of cataract surgery not only depends on the equipment used and the IOL implanted, but on the skill of the surgeon, your overall health, and where you live in the country. 0000015806 00000 n Please fill out the contact form so the right person can be in touch quickly. hb```f`` vAX,Xf000Z\ q1=nIc /( About Us; Staff; Camps; Scuba. SurgeryPlus is included in your medical benefits at no additional cost to you. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. SurgeryPlus offers surgical procedures that are covered under the State Group Health Insurance Program, but is different from your health insurance plan because the healthcare services are "bundled" together. Yes. Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. 0000007939 00000 n ii AF! Adjustable straps allow for a better, customized fit. Elected Officials Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. Mon-Fri, 8:30am-5:00pm (CT). Medicare covers hospice care if the following conditions are met: Medicare does help cover some in-home health services, including: To be eligible, you must be under the care of a doctor and treated under a plan of care that is monitored and reviewed by your doctor. At time of enrollment, you will choose how you want to pay. Coverage will be considered under your out-of-network benefits. Mastectomy surgery is a significant life event for many people. Hospice care, Medicare.gov, last accessed June 10, 2022. Contact us or connect with customer service by calling the number on your health plan ID card to ask for a copy in the language you need. What Part B covers, Medicare.gov, last accessed June 10, 2022. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. Trust in our network Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 0000378718 00000 n Privacy Policy If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. Help Center hb``P```e```5c@L@q EP0 Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. If your current dentist does not participate in the network and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application. 0000001266 00000 n To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. To get one, contact us. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage. 0000024865 00000 n Each company is a separate entity and is not responsible for another's financial or contractual obligations. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. It is not to be used for medical advice, diagnosis or treatment. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. 0000023776 00000 n Transparency startxref So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment. Adjusting to the physical changes post-surgery can be difficult, and finding the right mastectomy bra is one of the most important steps in the process. Complete and submit the form and well be in touch soon. SurgeryPlus offers surgical procedures that are covered under the State Group Health Insurance Program, but is different from your health insurance plan because the healthcare services are bundled together. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. h`06NH+500 0000418667 00000 n 10739 Deerwood Park Blvd, Suite 200-B E-mail / Text Alerts The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Read your certificate of insurance for details on plan benefits, limitations, and exclusions. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. To see if your procedure is covered, contact us. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Medicare won't cover Lasik surgery just to avoid the need for glasses. Austin, TX 78735 This type of surgery is only used for people who are very overweight and have not been able to lose weight with diet and exercise. Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. Policy form GPNP99. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. You pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees. It all depends on your policy. SurgeryPlus offers a variety of medical procedures, including the following: Terms and Conditions | Privacy Statement | Accessibility Statement | Sitemap, Monthly Webinars / Educational YouTube Videos, Making plan changes with a Qualifying Status Change (QSC) Event. Refer to the customer's benefit plan document for coverage details. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. If you are enrolled in a medical option through American (except DFW ConnectedCare) and have a covered surgery coming up, SurgeryPlus will: This is a voluntary benefit available to you if youre enrolled in the Core, Standard, Plus, High Cost Coverage, PPO 80 or PPO 90 medical option. If you need cataract surgery in both eyes . hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. Please refer to your Evidence of Coverage or call Customer Service at the number on the back of your Humana ID card to confirm that the service will be covered by your plan. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. ic+C@nN`RYva@\}KRr>Wq8=Rw+{a .n!LF40d=DdcB42r7hRXyMQ"wDYfuwO se)D+jd7bLB,2}a'_UOaB:.bwRIQGp)` aHeO\@qPtn#u,{n{@|=V<^N}Ap2,+H>0$_ -C Thats what SurgeryPlus does. Its also possible to get an SBC in another language. SurgeryPlus Frequently Asked Questions General Questions . Licensed Humana sales agents are available daily, 8a.m. 8 p.m. local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide; Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food; Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Other fixed Denture prosthetic services not described elsewhere in the certificate; Precision attachments, except when the precision attachment is related to implant prosthetics; Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it; Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Fixed and removable appliances for correction of harmful habits; Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards; Diagnosis and treatment of temporomandibular joint (TMJ) disorders. Confirm your coverage before you commit to a procedure youre unsure about. The estimate helps you prepare for the cost of dental services. 0000381088 00000 n In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. . The inclusion of a code does not imply any right to . To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. Disclaimer This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. <>/Filter/FlateDecode/ID[<4A8EC73074B5B2110A00B0B8D090FC7F>]/Index[988 109]/Info 987 0 R/Length 162/Prev 206109/Root 989 0 R/Size 1097/Type/XRef/W[1 3 1]>>stream 0000010311 00000 n SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, Many Medicare Advantage plans also provide prescription drug coverage (also known as Part D).5, Original Medicare does not include coverage for prescription drugs, but you can buy a stand-alone prescription drug plan to help manage your drug costs. Weather & Travel, Contact Us Medicare Part B benefits cover 80% of the Medicare-approved amount for cataract surgery. 1XQg&.9mE#(Tq& <. There are thousands of PDP Plus Network general dentists and specialists to choose from nationwide so you are sure to find one who meets your needs. An explanation of whats not covered and/or the limits on coverage, Information on costs you might have to pay like deductibles, coinsurance and copayments, Coverage examples, including how coverage works in the case of a pregnancy or a minor injury. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. TE 6Uz A$& &`5= X7"yH: wd`^+H(`q] DF9qt Guided Support Dependent age may vary by state. 0000392965 00000 n Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures.

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