49 • Social services and counseling services from a licensed social worker. • Nutritional support such as intravenous feeding and feeding tubes. • Physical therapy, occupational therapy, speech therapy, and respiratory therapy given by a licensed therapist. • Pharmaceuticals, medical equipment, and supplies needed for the palliative care of your condition, including oxygen and related respiratory therapy supplies. • Bereavement (grief) services, including a review of the needs of the bereaved family and the development of a care plan to meet those needs, both before and after the Member’s death. Bereavement services are available to the patient and those individuals w ho are closely linked to the patient, including the immediate family, the primary or designated caregiver and individuals with significant personal ties, for one year after the Member’s death. Your Doctor must agree to care by the Hospice and must be consulted in the development of the care plan. The Hospice must keep a written care plan on file and give it to us upon request. Benefits for services beyond those listed above that are given for disease modification or palliation, such as but not limited to chemotherapy and radiation therapy, are available to a Member in Hospice. These services are covered under other parts of thi s Plan. Human Organ and Tissue Transplant (Bone Marrow / Stem Cell) Services, Cellular and Gene Therapy Services Your Plan includes coverage for Medically Necessary human organ and tissue transplants as well as certain cellular and gene therapies . To be eligible for coverage, we must approve the benefits in advance through Precertification and services must be performed by an approved In - Network Provider to be covered at the In - Network level . Certain transplants (e.g., cornea) are covered like any other surgery, under the regular inpatient and outpatient benefits described elsewhere in this Booklet. In this section you will see some key terms, which are defined below: Covered Procedure As decided by us, a Covered Procedure includes: • Any Medically Necessary human solid organ, tissue, and stem cell / bone marrow transplants and infusions, and • Any Medically Necessary cellular or other gene therapies, and • Any Medically Necessary acquisition procedures, mobilization, collection and storage. It also includes Medically Necessary myeloablative or reduced intensity preparative chemotherapy, radiation therapy, or a combination of these therapies, Approved In - Network Provider A Provider who has entered into an agreement with us to provide Covered Procedures to you. The agreement may only cover c ertain Covered Procedures or all Covered Procedures. Approved In - Network Providers may include the following: • Blue Distinction Center (BDC) Facility : Blue Distinction facilities have met or exceeded national quality standards for care delivery of Covered Procedures.
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