67 36) Foot Surgery Surgical treatment of flat feet; subluxation of the foot; weak, strained, unstable feet; tarsalgia; metatarsalgia; hyperkeratosis. 37) Fraud, Waste, Abuse, and Other Inappropriate Billing Services from an Out - of - Network Provider that are determined to be not payable as a result of fraud, waste, abuse or inappropriate billing activities. This includes an Out - of - Network Provider's failure to submit medical records required to determine the appropriateness of a claim. 38) Free Care Services you would not have to pay for if you didn’t have this Plan. This includes, but is not limited to government programs, services during a jail or prison sentence, services you get from Workers’ Compensation, and services from free clinics. If your Employer is not required to have Workers Compensation coverage, this Exclusion does not apply. This Exclusion will apply if you get the benefits in whole or in part. This Exclusion also applies whether or not you claim the benefits or compensatio n, and whether or not you get payments from any third party. 39) Growth Hormone Treatment Any treatment, device, drug, service or supply (including surgical procedures, devices to stimulate growth and growth hormones), solely to increase or decrease height or alter the rate of growth. 40) Gene Therapy Gene therapy as well as any Drugs, procedures, health care services related to it that introduce or is related to the introduction of genetic material into a person intended to replace or correct faulty or missing genetic material. 41) Health Club Memberships and Fitness Services Health club memberships, workout equipment, charges from a physical fitness or personal trainer, or any other charges for activities, equipment, or facilities used for physical fitness, even if ordered by a Doctor. This Exclusion also applies to health sp as. 42) Hearing Aids Hearing aids, including bone - anchored hearing aids, or exams to prescribe or fit hearing aids and over - the - counter hearing aids , unless listed as covered in this Booklet. T his Exclusion does not apply to cochlear implants. 43) Home Health Care a) Services given by registered nurses and other health workers who are not employees of or working under an approved arrangement with a Home Health Care Provider. b) Food, housing, homemaker services and home delivered meals. 44) Hospital Services Billed Separately Services rendered by Hospital resident Doctors or interns that are billed separately. This includes separately billed charges for services rendered by employees of Hospitals, labs or other institutions, and charges included in other duplicate billings. 45) Hyperhidrosis Treatment Medical and surgical treatment of excessive sweating (hyperhidrosis). 46) Infertility Treatment Infertility procedures not specified in this Booklet . 47) Lost, Damaged, Destroyed or Stolen Drugs Refills of lost, damaged, destroyed or stolen Drugs . 48) Maintenance Therapy Rehabilitative treatment given when no further gains are clear or likely to occur. Maintenance therapy includes care that helps you keep your current level of function and prevents loss of that function but does not result in any change for the better. T his Exclusion does not apply to “Habilitative Services” as described in the “What’s Covered” section. 49) Medical Equipment, Devices and Supplies a) Replacement or repair of purchased or rental equipment because of misuse, abuse, or loss/theft. b) Surgical supports, corsets, or articles of clothing unless needed to recover from surgery or injury. c) Non - Medically Necessary enhancements to standard equipment and devices.
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