2020 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 70
 
Benefit Description

Organ/Tissue Transplants (cont.)

Related transplant services (continued):

 
  • Collection, processing, storage and distribution of cord blood only when provided as part of a blood or marrow stem cell transplant scheduled or anticipated to be scheduled within an appropriate time frame for patients diagnosed with one of the conditions listed on pages 66-68
     
  • Covered related medical and hospital expenses of the donor, when we cover the recipient
     
  • Covered services or supplies provided to the recipient
     
  • Donor screening tests for up to three non-full sibling (such as unrelated) potential donors, for any full sibling potential donors, and for the actual donor used for transplant

Note: See Section 5(a) for coverage for related services, such as chemotherapy and/or radiation therapy and drugs administered to stimulate or mobilize stem cells for covered transplant procedures.


You Pay
See previous page
 
Benefit Description

Travel benefits:
Members who receive covered care at a Blue Distinction Center for Transplants for one of the transplants listed on page 68 can be reimbursed for incurred travel costs related to the transplant, subject to the criteria and limitations described here.

You must obtain prior approval for travel benefits (see page 22).

You Pay
We reimburse costs for transportation (air, rail, bus, and/or taxi) and lodging if you live 50 miles or more from the facility, up to a maximum of $5,000 per transplant for the member and companions. Reimbursement is subject to IRS regulations.
 
Benefit Description
Not covered:

 
  • Any transplant not listed as covered and transplants for any diagnosis not listed as covered
     
  • Transplants performed in a facility other than the type of facility required for the particular transplant (see page 68 regarding transplants that must be performed in a Blue Distinction Center for Transplants and page 69 for transplants that must be performed in a Medicare-Approved Transplant Program
     
  • Donor screening tests and donor search expenses, including associated travel expenses, except as defined above
     
  • Implants of artificial organs, including those implanted as a bridge to transplant and/or as destination therapy, other than medically necessary implantation of an artificial heart as described on page 68
     
  • Implantation of an artificial heart in a facility not designated as a Blue Distinction Center for Heart Transplant
     
  • Allogeneic pancreas islet cell transplantation
     
  • Travel costs related to covered transplants performed at facilities other than Blue Distinction Centers for Transplants; travel costs incurred when prior approval has not been obtained; travel costs outside those allowed by IRS regulations, such as food-related expenses

You Pay
All charges