See page 26 in Section 3. If these activities are not completed by the dates listed above, the incentive will be forfeited. Breast pump limited to one per calendar year for members who are pregnant and/or nursing, Tubal ligation or tubal occlusion/tubal blocking procedures only. Whether you need to feel grounded, held, heard, lifted, freed, or something entirely unexpected, shell find a way to work with you. 14. We pay inpatient hospital benefits for an admission in connection with the treatment of children up to age 22 with severe dental caries. Gemma has a strong belief that living an active healthy lifestyle improves both longevity and quality of life. Caitlyn is committed to helping you achieve any goal and is dedicated to ensuring that she will be your best advocate, support system, and educator and provide evidence-based guidance during your rehabilitation journey. She enjoys working with people of all abilities and ages and believes in an evidence-based and individualised approach to help guide you towards your goals, whether that be moving out of pain, into performance, or onto prevention. Shannon is an exercise physiologist with a special interest in womens health and adolescent athletics. Follow Step 1 of the disputed claims process detailed in Section 8 of this brochure. The Local Plan Allowance varies by region and is determined by each Plan. During her time off Faith likes to mountain climb, mountain bike, play soccer and be down on the beach with her dog. The attachment of a tooth to the osseous (alveolar) housing is via the periodontal ligament. Expenses for care received from Non-preferred providers (Participating/Non-participating professional providers or Member/Non-member facilities), except for your deductible, coinsurance and/or copayments you pay in those situations where we do pay for care provided by Non-preferred providers. If you request that we review your claim as an urgent care claim, we will review the documentation you provide and decide whether or not it is an urgent care claim by applying the judgment of a prudent layperson who possesses an average knowledge of health and medicine. These conditions and errors are sometimes called Never Events or Serious Reportable Events.. Hospital services are listed in Section 5(c) and Surgical benefits are in Section 5(b). Jenn graduated with a Bachelor of Kinesiology from the University of Manitoba in Winnipeg, Manitoba, Canada. Sam is a graduate physiotherapist joining the Sports & Spinal team. Gabi has a strong interest in sport-related and is interested in incorporating this into her professional career. Ask your doctor, Who will manage my care when I am in the hospital?, How can I expect to feel during recovery?. Remember: Even if you do not file a claim with your other plan, you must still tell us that you have double coverage, and you must also send us documents about your other coverage if we ask for them. (See page 132. Mariella pursued further studies as an exercise physiologist after her experience as a Physiotherapist in Sri Lanka. She is certified in Functional Dry Needling Level 1 and Pelvic Health Level 1. Many, but not all, of these contracted providers are in our PPO (Preferred) network. Regular prescription drug benefits will apply to purchases of smoking and tobacco cessation medications not meeting these criteria. Do not maintain as a family member on your policy: Your former spouse after a divorce decree or annulment is final (even if a court order stipulates otherwise); or. She takes great pride and satisfaction in her treatments and knowing she has helped improve your mood, movement and relaxation. Clare is available for Womens Health appointments at our Hervey Bay clinic. Sam looks forward to bringing his knowledge and experience to Sports and Spinal and learning from his new colleagues and patients about the provision of exemplary physiotherapy care. Ray has always been involved with coordinating playgroups, mothers groups, kindy committees, and school committees to give them a sense of community and show them how important it is to be involved in social networks. Pat uses various Remedial techniques in his treatments, including Cupping, Dry Needling, Trigger Point Release, Muscle Energy Techniques, Myofascial Release, Rock blades Massage Tools, Deep Tissue Work, and Relaxation Massages. Follow Step 1 of the disputed claims process detailed in Section 8 of this brochure. Naomi understands that each client has different needs and values and provides an individualised approach. Zoe graduated from Griffith University with a Bachelor of Exercise Science and a Masters of Physiotherapy. Angle Orthod. Outpatientmedical or surgical services and supplies related to a medical emergency to include: Non-preferred professional providers (Participating and Non-participating): Note: Benefits for crutches, splints, braces, etc. They can also happen when you receive non-emergency services at participating facilities, but you receive some care from Non-participating providers. With the help of physicians, physios or time alone, your injury has settled down enough for you to get through most work, school or light household duties with only mild to moderate discomfort. Surgery for placement of penile prostheses to treat erectile dysfunction, For female to male surgery: mastectomy (including nipple reconstruction), hysterectomy, vaginectomy, salpingo-oophorectomy, metoidioplasty, phalloplasty, urethroplasty, scrotoplasty, electrolysis (hair removal at the covered operative site), and placement of testicular and erectile prosthesis, For male to female surgery: penectomy, orchiectomy, vaginoplasty, clitoroplasty, labiaplasty, and electrolysis (hair removal at the covered operative site). Dion is available for Physiotherapy appointments at our Kawana clinic. See page 68 for our coverage of acupuncture when provided as anesthesia for covered surgery. Covered professional providers within the United States, Puerto Rico, and the U.S. Virgin Islands are healthcare providers who perform covered services when acting within the scope of their license or certification under applicable state law and who furnish, bill, or are paid for their healthcare services in the normal course of business. Coverage under this Plan qualifies as minimum essential coverage. Since this time, Kurt has been working in injury prevention, Kurt has developed a passion for treating injuries whilst helping prevent them and improve the clients quality of life. For some people, ear congestion and pain will subside after TMD treatment, but can also continue sporadically after treatment in others. Alannah is available for Physiotherapy appointments at our Sippy Downslocations. Prescribed by your attending physician (i.e., the physician who is treating your illness or injury); Primarily and customarily used only for a medical purpose; Generally useful only to a person with an illness or injury; Used to serve a specific therapeutic purpose in the treatment of an illness or injury. Discrimination is Against the Law Preventing Medical Mistakes FEHB Facts Section 1. Ashleighs main interests are lower back, shoulder, knee, and ankle injuries. Orthopedic braces and prosthetic appliancessuch as: Note: A prosthetic appliance is a device that is surgically inserted or physically attached to the body to restore a bodily function or replace a physical portion of the body. We provide hospital benefits for internal prosthetic devices, such as artificial joints, pacemakers, cochlear implants, and surgically implanted breast implants following mastectomy; see Section 5(c) for payment information. Having competed internationally in sprint kayaking, he knows the importance of looking after your body and the demands of training and competing well to prevent injuries. Additional education includes Mulligan Manual Therapy, Acute Management of sports-related concussion and management of post-concussion syndrome, Advanced Concussion Course, Vestibular Rehabilitation and Temporomandibular Disorders (TMD) and Orofacial Pain. See Section 3 for information on pre-service claims procedures (services, drugs, or supplies requiring precertification or prior approval), including urgent care claims procedures. GMMI also offers emergency evacuation services to the nearest facility equipped to adequately treat your condition, translation services, and conversion of foreign medical bills to U.S. currency. Foster childrenCoverage: Foster children are eligible for coverage until their 26th birthday if you provide documentation of your regular and substantial support of the child and sign a certification stating that your foster child meets all the requirements. He conducted some biomechanical research into low back injuries in elite rowers in the School of Exercise and Sports Science at the University of Sydney for three years. If the state has no applicable licensing or certification requirement, the provider must meet the requirements of the Local Plan. You can find more information about how our Plan coordinates benefits with Medicare in our Medicare and You Guide for Federal Employees available online at www.fepblue.org. OPM will send you a final decision within 60 days. If a 31 to 90-day supply of a specialty drug has to be dispensed due to manufacturer packaging, you pay 40% of the Plan allowance (up to a $1,050 maximum) for each purchase (no deductible). Services, drugs, or supplies related to abortions, except when the life of the mother would be endangered if the fetus were carried to term, or when the pregnancy is the result of an act of rape or incest. For services received after 72 hours, see above. Note: Your physician must send a completed Coverage Request Form to CVS Caremark before you fill the prescription. The literature has shown that tooth interferences to the CR arc of closure activate the lateral pterygoid muscles7; posterior tooth interferences during excursive mandibular movements cause hyperactivity of the closing muscles8; and conversely, that the elimination of posterior excursive contacts by anterior guidance significantly reduces elevator muscle hyperactivity.9 Even small (50 m) occlusal interferences can initiate changes in coordinated muscle activity.10. This has allowed Tim to work and travel with sporting teams (including the Queensland Womens AFL Academy and Mens Australian University Rugby 7s team) as well as elite individual athletes who have competed at the Commonwealth Games and Paralympics. Amy is available for Dietetic appointments at Broadbeach and Robina. For example, after your first 10 visits (primary care, specialist or other healthcare provider), you will have a deductible to satisfy of $500 and then you will pay 30% of the Plan allowance for the visit. Make sure your medication is what the doctor ordered. She focused her post-graduate studies in these areasmaking sure all treatment and advice are up to date and evidence-based to provide the most optimal outcome for the client. The right of reimbursement is cumulative with and not exclusive of the right of subrogation. If your prescription requires prior approval and you have not yet obtained prior approval, you must pay the full cost of the drug or supply at the time of purchase and file a claim with the Retail Pharmacy Program to be reimbursed. After the primary plan pays, we will pay what is left of our allowance, up to our regular benefit. Outside of work, Amy enjoys time in nature bushwalking, kayaking, gardening and travelling. Typically, earwax moves through your ear canal and falls out on its own or is washed away when it reaches the outside of your ear, meaning you dont typically need to do any sort of cleaning. WRAP benefits provide the final layer of protection and complete or wrap-up the FEP Blue Focus benefit package. When a non-dental physical impairment exists that makes hospitalization necessary to safeguard the health of the patient (even if the dental procedure itself is not covered). Working with the body in a 360-degree approach is a personal goal of hers and is aiming to build upon her knowledge and expertise in this field. Dion has a keen interest in AFL and Rugby Union outside of work. Keep and bring a list of all the medications you take. Clark GT, Langham F, Flack VF. She has a passion for education and mentoring. See page 98 for information about your cost-share for specialty drugs purchased at a Preferred retail pharmacy that are affected by these restrictions. The monkeys positioned in CR did not experience changes in the condyles. This can include bladder, bowel, or sexual dysfunction relating to incontinence, haemorrhoids, pregnancy and post-partum, pelvic pain conditions, dyspareunia, or post-gender affirmation surgery. CHAMPVA provides health coverage to disabled Veterans and their eligible dependents. Any surgical procedure or any portion of a procedure performed primarily to improve physical appearance through change in bodily form, except for repair of accidental injury, or to restore or correct a part of the body that has been altered as a result of disease or surgery or to correct a congenital anomaly. Box 260070, Pembroke Pines, FL 33026. We will reduce our benefits by $100 for medically necessary services that require prior approval, if no one contacts us for prior approval. 15. See page 96 for more information. Paul is available for Physiotherapy appointments at our St Lucia clinic. Whether you need to feel grounded, held, heard, lifted, freed, or something entirely unexpected, shell find a way to work with you. You did not obtain prior approval when required (see page 22). Her definition of wellness includes lots of yoga, coffee, cats, meditation, self-help books, and kitchen experiments with mixed results. Medical University, Chennai, India and later went on to pursue his Post Graduate Diploma in Developmental rehabilitation, from Osmania University. Newborns of covered children are insured only for routine nursery care during the covered portion of the mother's maternity stay. Carly is likely to be found out on the run with her dog Ollie when shes not at the clinic or out to breakfast with friends. In his downtime away from work and studies, he enjoys eating at different ramen restaurants, travelling, and hitting the gym. contact your provider or a hearing specialist. 8. If you receive both preventive and diagnostic services from your Provider on the same day, you are responsible for paying your cost-share for the diagnostic services. As a result, she has become driven to provide holistic care with the aim of helping individuals regain their mobility and functionality as well as improving the methods of injury prevention and rehabilitation. If your physician: Opts-out of Medicare via private contract and is in our Preferred networkThen you are responsible for: your deductibles, coinsurance, copayments, and any balance your physician charges. Aleks has 15 years of experience as a Podiatrist with over 30,000 patient consultations. Blair understands that everyone has unique needs and delivers tailored care, specific to each client. In her spare time, she enjoys playing a variety of sports including tennis, basketball and badminton and travelling the globe. We base payment on whether a facility or a healthcare professional bills for the services or supplies. Claire is passionate about furthering her knowledge to improve patient care and has a keen interest in Womens Health. FEP Blue Focus Benefits (FEP Blue Focus) Section 5. To make your request, please call us at the customer service phone number on the back of your ID card, or send your request to us at the address shown on your explanation of benefits (EOB) form for the Local Plan that processed the claim (or, for Prescription drug benefits, our Retail Pharmacy Program, or the Specialty Drug Pharmacy Program). Changes to the prior approval list or to prior approval criteria are not considered benefit changes. If jaw pain, facial pain, or sleep disorders plague you, let us help! Note: See Section 5(c) for services billed for by a facility, such as the outpatient department of a hospital. This Plan is accredited. She also has experience in the private hospital sector and aged care. He excels in treatments for deep tissue massage, neck pains, and postural imbalances. It is important to know that a physician who does not accept Medicare assignment may not bill you for more than 115% of the amount Medicare bases its payment on, called the limiting charge. The Medicare Summary Notice (MSN) form that you receive from Medicare will have more information about the limiting charge. Except for necessary technical terms, we use common words. 6. Kyla is an exceptional hands-on manual Physiotherapist. If jaw pain, facial pain, or sleep disorders plague you, let us help! You can usually wait it out by trying to relieve congestion and swelling in your nose and throat, the culprits keeping your eustachian tubes from opening and releasing pressure4. Jake has a strong exercise background with experience in training for swimming and powerlifting, as well as personal training. Receiving information on the types of life-sustaining treatments that are available, completing advance directives and other standard forms, and/or if you are diagnosed with a terminal illness and making decisions about the care you would want to receive if you become unable to speak for yourself. Julie graduated from the University of Otago in New Zealand in 1998 and has gained a wealth of experience working in busy clinics around the world, including a professional sports centre in France, the Crystal Palace National Sports Centre in London, and a clinic in the ski resort of Verbier in Switzerland. Chloe graduated from the Registered Massage Therapy Program at CDI College and passed the board exam in 2020 after receiving a Bachelor of Arts degree in Photography. 1991;100:266-273. approach to diagnosing and managing disorders of the shoulder joint and surrounding structures, Conservative management of shoulder rotator cuff tears, Feasibility and acceptability of a standardised shoulder exercise program for supraspinatus full-thickness tears, Nutrition plans tailored to the individual. A careful medical/dental history along with a comprehensive examination is necessary for all patients, but especially those with facial pain, TMD, or bruxism. The timely filing deadline for overseas pharmacy claims is limited to one year from the prescription fill date. She is currently studying allied health and looking forward to putting her learning into practice. Pre-surgical testing performed within one business day of the covered surgical services, Visits to the outpatient department of a hospital for non-emergency treatment services, Administration of blood, blood plasma, and other biologicals, Blood and blood plasma, if not donated or replaced, and other biologicals, Facility supplies for hemophilia home care. Tim is motivated to provide the best possible care to his clients and help them achieve their health and fitness goals. If you are asked to sign this type of waiver, please be aware that, if benefits are denied for the services, you could be legally liable for the related expenses. Annaliese is very passionate about movement and exercise, and their influence not only on physical health but also mental health. Gema is passionate about empowering each individual to play an important role in their health journey. Maddie is available for Podiatry appointments at our Caloundra and Sippy Downs clinics. We will still limit our payment to the amount we would have paid after Original Medicares payment. James graduated from the University of the Fraser Valley with a Bachelor of Kinesiology and a Minor in Communications. Rod believes in the systematic assessment and treatment of muscles, tendons, ligaments and connective tissues of the body to assist in rehabilitation, pain and injury management caused by sports and work-related injuries, post-surgery rehabilitation and general soreness from a wide variety of activities and postures. Blue Cross and Blue Shield Service Benefit PlanFEP Blue Focus. A clinical trial has possible benefits as well as risks. 5. To find out if you need to do something to file your claims, call us at the customer service phone number on the back of your ID card or visit our website at www.fepblue.org. Emma grew up in Melbourne but relocated to New Zealand to study a Bachelor of Physiotherapy at the University of Otago. Hornbrook D. A look at a promising device for treating TMJ, migraine pain. An episode consists of up to seven consecutive days of continuous care. Sherrys interest in holistic healing and her passion for helping people led her to massage thera Such methods may include cupping, passive stretches, trigger point, and myofascial therapy. 1988;2:87-95. Any procedure, injection, diagnostic service, laboratory, or X-ray service done in conjunction with a routine examination and not included in the preventive listing of services will be subject to the applicable member copayments, coinsurance, and deductible. This law mandates that you be enrolled for Self Plus One or Self and Family coverage in the FEHB Program, if you are an employee subject to a court or administrative order requiring you to provide health benefits for your child or children. She has worked with AFL and rugby league development teams and individual athletes and provided mindfulness for the Australian Olympic Teams during quarantine. Shannon has been on the Sunshine Coast for the last 6 years and enjoys spending her time cooking as well as hiking the local trails. (For concurrent care claims that are also urgent care claims, please see If your treatment needs to be extended on page 26. He has extensive experience working with athletes at an elite and everyday level. Read More. In such cases, the hospitalized family members benefits under the new plan begin on the effective date of enrollment. Having dealt with multiple concussions and chronic shoulder impingement himself, he knows how important recovery is in the rehabilitation process for any injury. Relevant Links: Blue Cross and Blue Shields fepblue mobile application is available for download for both iOS and Android mobile phones. We limit our payment to an amount that supplements the benefits that Medicare would pay under Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), regardless of whether Medicare pays. Refer to the bottom of page 64 and the top of page 65 for information about blood or marrow stem cell transplants covered only in clinical trials and the additional requirements that apply. Outpatient professional services including: We cover outpatient mental health and substance use disorder services or supplies provided and billed by residential treatment centers at the levels shown here. Note: See Section 5(i), page 108, for information on how to file claims for overseas services. ), For outpatient services resulting from a medical emergency or accidental injury and billed by a Non-member facility, our allowance is now the lesser of the billed amount or the qualifying payment amount (QPA) determined in accordance with federal laws and regulations. Enrollees name and Plan identification number; Patients name, birth date, and phone number; Reason for inpatient admission, proposed treatment, or surgery; Name and phone number of admitting physician; Number of days requested for hospital stay; Any other information we may request related to the services to be provided; and. Note: When care is provided by a Non-preferred laboratory and/or radiologist, as stated on page 18 for an exception, you pay: Benefits are provided for preventive care services for adults age 22 and over. You can find Tallara on top of a mountain, indoor rock climbing, or drinking coffee under a Brisbane fig tree in her spare time. Click below to see the people whose lives have been changed by The TMJ & Sleep Therapy Centre. He has also recently undertaken certification to offer the GLA:D program; the best evidence management for hip & knee osteoarthritis. If your ear feels clogged, there are numerous ways to find relief. This is called double coverage.. A physician may have opted-out of Medicare and may or may not ask you to sign a private contract agreeing that you can be billed directly for services ordinarily covered by Original Medicare. Fee-for-service plans determine their allowances in different ways. We determine our allowance as follows: Important notice about using Non-participating providers! From this passion, Kurt gained entry into a Masters of Clinical Exercise Physiology at the Australian Catholic University, which he has since completed. If we do not receive the information within 60 days, we will decide within 30 days of the date the information was due. Sophies interests are in Womens Health. The English versions of your EOBs and related correspondence will include information in the non-English language about how to access language services in that non-English language. Soft rubber splints, however, do not provide the characteristics necessary for successful splint therapy. Some clinics may not be open due to the pandemic. Its produced by skin glands located on the outer half of your ear canals to lubricate your ears and prevent dust and other particles from entering your eardrum, according to the Mayo Clinic. Adrian also uses cupping and dry needling in his treatments where possible. If the physician does not, report the physician to the Medicare carrier that sent you the MSN form. Ashlyn is available for Physiotherapy appointments at our Buderim clinic. She is qualified to treat Lymphoedema in the upper and lower limbs, breasts, genitals, trunk, abdomen, and paediatrics. To correct an impairment directly caused by a single instance of accidental ocular injury or intraocular surgery; If the condition can be corrected by surgery, but surgery is not an appropriate option due to age or medical condition; For the nonsurgical treatment for amblyopia and strabismus, for children from birth through age 21. If matters beyond our control require an extension of time, we may take up to an additional 15 days for review and we will notify you of the need for an extension of time before the end of the original 15-day period. When you are injured and benefits are available to you or your dependent, under any law or under any type of insurance, including, but not limited to: No-fault insurance and other insurance that pays without regard to fault, including personal injury protection benefits, regardless of any election made by you to treat those benefits as secondary to this Plan, Uninsured and underinsured motorist coverage, We will waive our calendar year deductible and coinsurance. Note: Using Non-participating or Non-member providers (Non-preferred) when an exception is granted (see page 18) could result in your having to pay significantly greater amounts for the services you receive. This is what you will pay out-of-pocket for your covered care: Cost-share or cost-sharing is the general term used to refer to your out-of-pocket costs (e.g., deductible, coinsurance, and copayments) for the covered care you receive. However, special rules apply when Medicare or another payer is primary, see pages 23-24. Having played semi-professional level basketball since the age of 15, Leilani is well aware of the impact that injuries can have on our bodies, both physically and mentally. Magnusson T, Carlsson GE. Simon has over 20 years of experience as a physiotherapy clinician, educator, and clinic owner. OTC medications: Take anti-inflammatory meds to help reduce symptoms. She has completed a Bachelor of Clinical Exercise Science and has gained accreditation as an Exercise Physiologist (AEP). Personal and professional development are both key takeaways from his time overseas (and of course a repertoire of travel tales). We pay benefits when we receive a claim for covered services. If Medicare offers an approved program for an anticipated organ transplant, but your facility is not approved by Medicare for the procedure, please contact your Local Plan at the customer service phone number appearing on the back of your ID card. Steve believes in functional training and getting to the cause of your problems, leading to a longer-lasting and more effective long-term result. Manipulative treatment and acupuncture services, limited to a combined 10 visits per person. We, like other insurers, determine which coverage is primary according to the National Association of Insurance Commissioners (NAIC) guidelines. How You Get Care Section 4. Topical Hyperbaric Oxygen Therapy (THBO). She moved back to Hervey Bay with her husband to raise her young family and enjoy the beautiful Fraser Coast. Carly has a passion for working with her patients to help them overcome injury and return to optimal function. If your drug is moved to noncovered, you pay the full cost of the medication. Influence of the vertical dimension in the treatment of myofascial pain-dysfunction syndrome. They may not seek more than their governing laws allow. Simran has developed a particular interest in knee and ankle injuries and uses a mixed approach of hands-on therapy and tailored exercise prescription to ensure that each of her patients achieves their goals. Note: Congenital anomalies do not include conditions related to the teeth or intra-oral structures supporting the teeth. Edward is available for appointments at our Maroochydore location. In his spare time, Kale enjoys AFL and cricket as a supporter and a player, trying his best to catch a wave and spending time outdoors. If a sports injury, car accident, or sore muscles and joints are causing you sleepless nights and stressful days, its time to get help. If the stay is not medically necessary, we will not provide benefits for inpatient hospital room and board or inpatient physician care; we will only pay for covered medical services and supplies that are otherwise payable on an outpatient basis. Outside of work, Daniel has a passion for many sports, including AFL, cricket and basketball. When we are the primary payor, we process the claim first. Go to www.fepblue.org/telehealth or call 855-636-1579, TTY: 855-636-1578, toll free to access this benefit. Contact us or, if we drop out of the Program, contact your new plan. If you have questions about treatment at an RTC, please contact us at the customer service phone number listed on the back of your ID card. Alex is available for appointments at our Woolloongabba clinic. If an in-network provider bills you for covered services over your normal cost share (deductible, copay, coinsurance) contact your Carrier to enforce the terms of its provider contract. Devin follows an evidence-based approach to Massage and believes that Massage Therapy plays an im Vijay Raj is an internationally trained physical therapist with over 12 years of experience treating various musculoskeletal conditions, sports injuries, and pre- and post-operative conditions. Using Deep tissue Trigger points and many other techniques to help improve pain and movement. Outside the clinic, Claire enjoys hiking, open water swimming, and travelling. Note: We are unable to ship drugs, through our Specialty Drug Pharmacy Program, to overseas countries that have laws restricting the importation of prescription drugs from any other country. Your employing or retirement office will not notify you when a family member is no longer eligible to receive health benefits, nor will we. Her positive and welcoming attitude makes you feel at ease through your journey of recovery and a healthier lifestyle. Once enrolled in your FEHB Program Plan, you should contact your carrier directly for updates and questions about your benefit coverage. Ray is available for Remedial Massage Apooitnments at our Robina clinic. Note: Benefits are not available for routine adult physical examinations, associated laboratory tests, colonoscopies, or routine immunizations performed at Non-preferred (Member/Non-member) facilities. In 2016, Lorelei received her Doctorate of Chiropractic. The purpose of the tubes is to let fluid drain from behind the ear drum to prevent trauma or infection and also regulate air pressure between the environment and the middle ear.. Emily is available for Psychology appointments at our Chermside, North Lakes, and Springfield clinics. For more information about prior approval, please refer to page 20. Blair is available for Exercise Physiology appointments in Maroochydore and Caloundra. Using national evaluation criteria developed with input from medical experts, the Blue Distinction Centers offer comprehensive care delivered by multidisciplinary teams with subspecialty training and distinguished clinical expertise. Benefits for specialty drugs purchased at a Preferred retail pharmacy are limited to one purchase of up to a 30-day supply for each prescription dispensed. Working in the field for almost a decade, Dion has completed a post-graduate Masters in Physiotherapy on a background of a Bachelors degree in Sport and Exercise Science. For a complete list of immunizations go to the Centers for Disease Control (CDC) website at, USPSTF A and B recommended screenings such as cancer, osteoporosis, depression, and high blood pressure. Limits of human bite strength. Contact your human resources office or retirement system for additional information. (See page 29. When we are the secondary payor, we will determine our allowance. We may seek a first priority lien on the proceeds of your claim in order to reimburse ourselves to the full amount of benefits we have paid or will pay. You can also get care for the treatment of minor acute conditions (see page 131 for definition), dermatology care (see page 39), and counseling for behavioral health and substance usedisorder (see page 86), and nutritional counseling (see pages 41 and 44), using teleconsultation services delivered via phone by calling 855-636-1579, TTY: 855-636-1578, or via secure online video/messaging at www.fepblue.org/telehealth. tmj D is an overworking or stiff tmj as another article but also cause bad jaw neck and shoulders. Our FEP medical policies may be found by visiting www.fepblue.org/policies. International shipping is not available. We cover up to a combined total (medical and mental health) of 30 days of inpatient care provided and billed by an RTC for members enrolled and participating in case management through the Local Plan, when the care is medically necessary for treatment of a medical, mental health, and/or substance usedisorder: Outpatient services provided and billed by a covered facility. The calendar year deductible is not applicable when purchasing drugs at pharmacies located overseas. Those claims (1) that require precertification or prior approval, and (2) where failure to obtain precertification or prior approval results in a reduction of benefits. We may provide our decision orally within these time frames, but we will follow up with written or electronic notification within three days of oral notification. Read More. To order your free glucose meter kit, call us toll-free at 855-582-2024, Monday through Friday, from 9 a.m. to 7 p.m., Eastern Time, or visit our website at www.fepblue.org. The choice of the arch for which the splint is fabricated is dictated by the type of bruxism habit. He turned this injury into a passion to rehabilitate and assist people to return to pain-free lifestyles and live happy healthy lifestyles. 1994;52:671-679. She has a passion for helping women achieve a healthy and happy quality of life. Previously, one EKG per calendar year was covered under the preventive care adult benefit with no member cost-share. This is part!tmj. We provide benefits at Preferred benefit levels for emergency department services performed by both PPO and non-PPO providers when their services are related to an accidental injury or medical emergency. Note: When we pay secondary to primary coverage you have from a prepaid plan (HMO), we base our benefits on your out-of-pocket liability under the prepaid plan (generally, the prepaid plans copayments), subject to our deductible and coinsurance or copayment amounts. She has also recently completed NOI group explain pain course, enabling her to work with more complex pain conditions. Nicholas enjoys all things outdoors, and his favourite sport is soccer, where he has played interstate and overseas. For listings of Blue Distinction Centers, visit https://www.bcbs.com/blue-distinction-center/facility; access our National Doctor & Hospital Finder via www.fepblue.org/provider; or call us at the customer service phone number listed on the back of your ID card. More information on the Act is available on the following Federal Government websites: The calendar year deductible is $500 per person ($1,000 per Self Plus One or Self and Family enrollment). Our review will include whether you meet the facility andtransplant program criteria for the particular transplant.All members (including those who have Medicare Part A or another group health insurance policy as their primary payor) must contact us at the customer service phone number listed on the back of their ID card before obtaining services. See page 19. See page 18 for the exceptions to this requirement. Jaime has completed post-graduate study and many advanced courses in pelvic health; taught university students both on an undergraduate and postgraduate level; presented at international conferences; headed the Allied Health teams for Persistent Pelvic Pain clinics in the areas of Endometriosis and Pelvic Mesh injuries, and worked in both the public and private sectors of health and Physiotherapy. FEP Blue Focus Benefits Jaydens last two years were spent as the Head of Physiotherapy for one of Londons biggest Private Physiotherapy companies managing Ten clinics and a large number of health professionals. Medically necessary emergency ground, air and sea ambulance transport services to the nearest hospital equipped to adequately treat your condition if you travel outside the United States, Puerto Rico and the U.S. Virgin Islands. Under the telehealth benefit, you have on-demand access to care for common, non-emergent conditions. Please stay home if you are feeling sick. In general, muscle disorders are effectively treated with appropriate splint therapy (bite planes and stabilization appliances). Simran is available for Physiotherapy appointments at our Chermsidelocation. All remaining family members will be required to meet the balance of the catastrophic protection out-of-pocket maximum. Renee is available for Physiotherapy appointments at our Kawanalocation. Outside of work, Emily is passionate about health and fitness and will regularly be found in the gym or eating at one of QLDs best restaurants. 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