Не знаю, что делать..

[zvizda]

Нет. Не берут. [Under HIPAA], они обязаны брать только в определённых условиях. После Меди-Кела - не обязаны брать.

Я, кстати, тоже про это читала, когда лопатила инфу. Они берут только в том случае, если был непрерывающийся каверадж в страховой компании мин.18 месяцев or something like that.

[Акватрель]

Платина?

На самом деле, я тебе скажу, это великий шаг..Я воспылала уважением к нашему незнакомцу, прям держитиминясемеро
:evillaugh :cheer:

[Буржуй]

На самом деле, я тебе скажу, это великий шаг..Я воспылала уважением к нашему незнакомцу, прям держитиминясемеро
:евиллаугх :чеер:

Я должен с тобой согласиться. Я сижу и думаю, сделал бы я тоже самое? Честоно говоря не знаю. :-(

[Ватрушка]

На самом деле, я тебе скажу, это великий шаг..Я воспылала уважением к нашему незнакомцу, прям держитиминясемеро
:evillaugh :cheer:

тихи тихо, не задуши его (молодец человек)

[Ватрушка]

Я должен с тобой согласиться. Я сижу и думаю, сделал бы я тоже самое? Честоно говоря не знаю. :-(

я бы сделала, будь у меня возможность.

[Буржуй]

я бы сделала, будь у меня возможность.

Ты лучше меня как человек, я подумав должен признать что наверное бы на ето не пошел.

[zvizda]

Ребята, секундочку внимания.. Вот некоторые выдержки из плана. Кто-то, кто рубит фишку (Одинокий Остров?), можете взглянуть, чем мне это грозит? Смотрю в книгу, вижу фигу - с терминологией мало знакома.


Plan feature Coverage amount
Deductible Individual: None
Family: None
Out-of-pocket maximum: Individual: $1,500; Family: $4,500;
$3,000 for employee plus one dependent.

Office visits: Plan pays 100% after your $15 copay
Hospital stay: Plan pays 100%
Surgery in a hospital: Plan pays 100%
Prescription drugs: You must see a pharmacy in the Blue Shield of
California network.
Generic: Plan pays 100% after $10 copay
Brand-name preferred/Non-preferred: Plan pays
100% after $15 brand-name/$30 non-preferred copay
Lifetime maximum

Далее:

Q: Are there limits for pre-existing conditions?

A: There are no exclusions or limitations for pre-existing conditions.

Q: What is not covered under the plan?

A: The plan does not cover:

* Blood transfusions, including blood processing, the cost of
blood, unreplaced blood and blood products, are covered. However,
self-donated (autologous) blood transfusions are covered only for a
surgery that the contracting Physician Group has authorized and
scheduled.
* Clinical trials such as; drugs or devices that are not approved
by the FDA; services other than health care services, including but
not limited to cost of travel or costs of other non-clinical expenses;
services provided to satisfy data collection and analysis needs which
are not used for clinical management; health care services that are
specifically excluded from coverage and items and services provided
free of charge by the research sponsors to Members in the trial.
* Conception by Medical Procedures; Artificial insemination is
covered when a female Member and/or her male partner is infertile.
However, if only the male partner is a Member and the female partner
(who is not a member) is infertile, artificial insemination will not
be covered. The collection, storage nor purchase of sperm is not
covered. Other services or supplies that are intended to impregnate a
woman are not covered. Excluded procedures include, but are not
limited to: In-vitro fertilization (IVF), gamete intrafallopian
transfer (GIFT), zygote intrafallopian transfer (ZIFT) or any process
that involves harvesting, transplanting or manipulating a human ovum.
Also not covered are services or supplies (including injections and
injectable medications) which prepare the Member to receive these
services. Collection, storage, or purchase of sperm or ova.
* Cosmetic surgery or services and supplies performed to alter or
reshape normal structures of the body solely to improve the physical
appearance of a Member are not covered. In addition, hair
transplantation, hair analysis, hairpieces and wigs, chemical face
peels, abrasive procedures of the skin, liposuction or epilation are
not covered.
* Custodial or domiciliary care such as services and supplies that
are provided primarily to assist with the activities of daily living,
regardless of where performed. Custodial Care is not covered even when
the patient is under the care of a supervising or attending Physician
and services are being ordered and prescribed to support and generally
maintain the patient's condition or provide for the patient's comforts
or ensure the manageability of the patient. Furthermore, Custodial
Care is not covered even if ordered and prescribed services and
supplies are being provided by a registered nurse, a licensed
vocational nurse, a licensed practical nurse, a Physician Assistant or
physical therapist.
* Disposable supplies for home use
* Exercise equipment.
* Experimental or Investigational drugs, devices, procedures or
other therapies are only covered when: Independent review deems them
appropriate, or clinical trials for cancer patients are deemed
appropriate
* Eye surgery performed to correct refractive defects of the eye,
such as near-sightedness (myopia), far-sightedness (hyperopia) or
astigmatism.
* Eyeglasses or contact Lenses. However, this exclusion does not
apply to an implanted lens that replaces the organic eye lens.
* Foot orthotics, (whether or not custom fit) that are not
incorporated into cast, splint, brace or strapping of the foot, unless
purchased by your Group as a specific benefit for foot orthotics.
* Genetic testing and diagnostic procedures is limited to prenatal
diagnosis of fetal genetic disorders in cases of high risk pregnancy
as determined by Health Net and the Member's Physician. Other
diagnostic procedures or testing for genetic disorders are not
covered.
* Hearing aids: This Plan does not cover any device inserted in or
affixed to the outer ear to improve hearing.
* Home birth; A birth which takes place at home will be covered
only when the criteria for Emergency Care, as defined in your benefits
section.
* Hygienic equipment and supplies (to achieve cleanliness even
when related to other covered medical services)
* Jacuzzis and whirlpools.
* Non-eligible institutions; This Plan only covers services or
supplies provided by a legally operated Hospital, Medicare-approved
Skilled Nursing Facility or other properly licensed facility specified
that is primarily a place for the aged, a nursing home or a similar
institution, regardless of how it is designated, is not an eligible
institution. Services or supplies that are provided by such
institutions are not covered.
* Nonprescription (Over-the-Counter) drugs, equipment and
supplies: Medical equipment and supplies (including insulin), that
are available without a prescription, are covered when prescribed by a
Physician for the management and treatment of diabetes. Any other
nonprescription drug, medical equipment or supply that can be
purchased without a Prescription Drug Order is not covered, even if a
Physician writes a Prescription Drug Order for such drug, equipment or
supply.
* Orthotics, unless custom made to fit the Member's body.
(Orthotics are supports or braces for weak or ineffective joints or
muscles.)
* Orthotics, whether or not custom fit, to treat dental conditions
related to TMJ disorder.
* Personal or comfort items.
* Physician self-treatment rendered in a non-emergency. Physician
self-treatment occurs when Physicians provide their own medical
services, including prescribing their own medication, ordering their
own laboratory test and self-referring for their own services. Claims
for emergency self-treatment are subject to review by Health Net.
* Private duty nursing in the home for registered bed patients in
a Hospital or long-term care facility.
* Rehabilitation therapy is limited to services after an acute
episode of care for chronic conditions, an acute illness or injury or
an acute exacerbation of such an illness or injury. Additionally, this
Plan does not cover rehabilitation therapy services (physical, speech
and occupational therapy) provided in connection with the treatment of
the following conditions: Psychosocial speech delay (includes delayed
language development). Mental retardation or dyslexia. Attention
deficit disorders and associated behavior problems. Developmental
articulation and language disorders. However, some of the above
conditions shall be covered when Medically Necessary.
* Services or supplies for which you are not legally required to
pay or for which no charge is made.
* Services or supplies provided before the Effective Date of
coverage. Services or supplies provided after coverage through this
Plan has ended are not covered, unless otherwise specified.
* Stockings, corrective shoes and arch supports.
* Surgical dressings other than primary dressings that are applied
by your Physician Group or a Hospital to lesions of the skin or
surgical incisions.
* This Plan does not cover routine or ongoing treatment or
consultation provided by the Member's parent, spouse, child or
sibling. Members who receive routine or ongoing care from a member of
their immediate family may be reassigned to another Physician.
* Unlisted services
* Experimental or Investigational in Nature except for Services
for Members who have been accepted into an approved clinical trial for
cancer as provided under Clinical Trial for Cancer;
* or or incident to services rendered in the home or
hospitalization or confinement in a health facility primarily for
Custodial, Maintenance, or Domiciliary Care except as provided under
Hospice Program Services; or rest;
* for substance abuse treatment or rehabilitation on an Inpatient,
Partial Hospitalization or Outpatient basis, except as specifically
provided under Mental Health and Substance Abuse Services or the
supplement for Inpatient Substance Abuse Treatment;

[Дженни]

А ко мне наоброт все пристают - "а у тебя есть документы? а то давай я на тебе женюсь!"

Прям эпидемия какая-то.

[zvizda]

* performed in a Hospital by Hospital officers, residents, interns
and others in training;
* for or incident to hospitalization or confinement in a pain
management center to treat or cure chronic pain, except as may be
provided through a Participating Hospice Agency and except as
Medically Necessary;
* or Cosmetic Surgery or any resulting complications, except that
Medically Necessary Services to treat complications of Cosmetic
Surgery (e.g., infections or hemorrhages) will be a Benefit, but only
upon review and approval by a Blue Shield Physician consultant.
Without limiting the foregoing, no benefits will be provided for the
following surgeries or procedures:
* -- Lower eyelid blepharoplasty; Spider veins; Procedures to
smooth the skin (i.e., chemical face peels, laser resurfacing, and
abrasive procedures); Hair removal by electrolysis or other means; and
Reimplantation of breast implants originally provided for cosmetic
augmentation;
* incident to an organ transplant; except as provided under
Transplant Benefits;
* for convenience items such as telephones, TVs, guest trays, and
personal hygiene items;
* for transgender or gender dysphoria conditions, including but
not limited to intersex surgery (trans-sexual operations), or any
related services, or any resulting medical complications, except for
treatment of medical complications that is Medically Necessary;
* for any services related to the harvesting or stimulation of the
human ovum, in vitro fertilization, Gamete Intrafallopian Transfer
(G.I.F.T.) procedure, or any other form of assisted fertilization
(including related medications, laboratory, and radiology services),
artificial insemination, services or medications to treat low sperm
count, or services incident to or resulting from procedures for a
surrogate mother. However, if the surrogate mother is enrolled in a
Blue Shield of California health plan, Covered Services for Pregnancy
and Maternity Care for the surrogate mother will be covered under that
health plan;
* for or incident to the reversal of a vasectomy or tubal
ligation, repeat vasectomy or tubal ligation;
* for or incident to Speech Therapy, speech correction, or speech
pathology or speech abnormalities that are not likely the result of a
diagnosed, identifiable medical condition, injury or illness except as
specifically provided under Home Health Care Services, PKU Related
Formulas and Special Food Products and Home Infusion Therapy; Speech
Therapy; and Hospice Program Services;
* for routine foot care including callus, corn paring or excision
and toenail trimming (except as may be provided through a
Participating Hospice Agency); treatment (other than surgery) of
chronic conditions of the foot, including but not limited to weak or
fallen arches, flat or pronated foot, pain or cramp of the foot,
bunions, muscle trauma due to exertion or any type of massage
procedure on the foot; for special footwear (e.g., non-custom made or
over-the-counter shoe inserts or arch supports) except as specifically
provided under Orthoses and Diabetes Care;
* for eye refractions (except as specifically provided under Eye
Examination Benefit), surgery to correct refractive error (such as but
not limited to radial keratotomy, refractive keratoplasty), lenses and
frames for eye glasses, contact lenses (except as provided under
Durable Medical Equipment, Prostheses, and Other Services);
* for hearing aids;
* for Dental Care or services incident to the treatment,
prevention, or relief of pain or dysfunction of the Temporomandibular
Joint and/or muscles of mastication, except as specifically provided
under Medical Treatment of the Teeth, Gums, Jaw Joints or Jaw Bones;
* for or incident to services and supplies for treatment of the
teeth and gums (except for tumors) and associated periodontal
structures, including but not limited to diagnostic, preventive,
orthodontic and other services such as dental cleaning, tooth
whitening, X-rays, topical fluoride treatment except when used with
radiation therapy to the oral cavity, fillings, and root canal
treatment; treatment of periodontal disease or periodontal surgery for
inflammatory conditions; tooth extraction; dental implants; braces,
crowns, dental orthoses and prostheses; except as specifically
provided under Hospital Services and Medical Treatment of the Teeth,
Gums, Jaw Joints or Jaw Bones;
* for or incident to reading, vocational, educational,
recreational, art, dance or music therapy; weight control or exercise
programs;

[zvizda]

* for learning disabilities, or behavioral problems;
* for or incident to acupuncture and acupressure, except as
specifically provided;
* for spinal manipulation and adjustment, except as specifically
provided under Professional (Physician) Services (other than for
Mental Health and Substance Abuse Services);
* for or incident to any injury or disease arising out of, or in
the course of, any employment for salary, wage or profit if such
injury or disease is covered by any workers' compensation law,
occupational disease law or similar legislation. However, if Blue
Shield provides payment for such services it will be entitled to
establish a lien upon such other benefits up to the reasonable cash
value of Benefits provided by BlueShield for the treatment of the
injury or disease as reflected by the providers' usual billed charges;
* in connection with private duty nursing, except as provided
under Hospital Services, Home Health Care Services, PKU Related
Formulas and Special Food Products and Home Infusion Therapy, and
Hospice Program Services;
* for testing for intelligence or learning disabilities;
* for rehabilitation services except as specifically provided
under Hospital Services, Home Health Care Services, PKU Related
Formulas and Special Food Products and Home Infusion Therapy, and
Outpatient Rehabilitation Sevices;
* for prescribed drugs and medicines for Outpatient care except as
provided through a Participating Hospice Agency when the Member is
receiving Hospice Services and except as may be provided under Home
Health Care Services, PKU Related Formulas and Special Food Products
and Home Infusion Therapy;
* for contraceptives and contraceptive devices, except as
specifically included in the Family Planning and Infertility Services
Benefit; oral contraceptives and diaphragms are excluded; no benefits
are provided for contraceptive implants;
* for transportation services other than provided under Ambulance Services;
* for unauthorized non-Emergency Services;
* not provided by, prescribed, referred, or authorized by a
Personal Physician or the Blue Shield HMO except for Access+
Specialist visits, OB/GYN Services provided by an obstetrician/
gynecologist or family practice Physician within the same Medical
Group/IPA as the Personal Physician, Emergency Services or Urgent
Services as provided under Emergency Services and Urgent Services,
when specific authorization has been obtained in writing for such
Services from the Plan, for Mental Health and substance abuse Services
which must be arranged through the MHSA or for Hospice Services
received by a Participating Hospice Agency;
* performed by a Close Relative or by a person who ordinarily
resides in the Subscriber's or Dependent's home;
* for orthopedic shoes, except as provided under Diabetes Care,
home testing devices, environmental control equipment, generators,
exercise equipment, self help/educational devices, or for any type of
communicator, voice enhancer, voice prosthesis, electronic voice
producing machine, or any other language assistance devices, except as
provided under Durable Medical Equipment, Prostheses, and Other
Services, vitamins, and comfort items;
* for physical exams required for licensure, employment, or
insurance unless the examination corresponds to the schedule of
routine physical examinations provided under Preventive Health
Services, or for immunizations and vaccinations by any mode of
administration (oral, injection or otherwise) solely, or for
immunizations for the purpose of travel;
* for penile implant devices and surgery, and any related services
except for any resulting complications and Medically Necessary
Services as provided under Reconstructive Surgery;
* for home testing devices and monitoring equipment except for use
of the peak flow monitor for self-management of asthma, the glucose
monitor for self-management of diabetes and the apnea monitor for
management of newborn apnea when authorized as Durable Medical
Equipment;
* for or incident to sexual dysfunctions and sexual inadequacies,
except as provided for treatment of organically based conditions;
* for non-prescription (over-the-counter) medical equipment or
supplies that can be purchased without a licensed provider's
prescription order, even if a licensed provider writes a prescription
order for a non-prescription item, except as specifically provided
under Home Health Care Services, PKU Related Formulas and Special Food
Products and Home Infusion Therapy, Hospice Program Services, Durable
Medical Equipment, Prostheses, and Other Services, and Diabetes Care;
* for Reconstructive Surgery and procedures: 1) where there is
another more appropriate surgical procedure that is approved by a Blue
Shield Physician consultant, or 2) when the surgery or procedure
offers only a minimal improvement in function or in the appearance of
the enrollees, e.g., spider veins, or 3) as limited under
Reconstructive Surgery;
* for drugs and medicines which cannot be lawfully marketed
without approval of the U.S. Food and Drug Administration (the FDA);
however, drugs and medicines which have received FDA approval for
marketing for one or more uses will not be denied on the basis that
they are being prescribed for an off-label use if the conditions set
forth in California Health and Safety Code, Section 1367.21 have been
met;
* for prescription or non-prescription food and nutritional
supplements, except as provided for PKU related formulas as described
under Home Health Care Services, PKU Related Formulas and Special Food
Products and Home Infusion Therapy;
* for genetic testing except as described under Other Outpatient
Services, and Pregnancy and Maternity Care;
* not specifically listed as a benefit.