28 Approved In-Network Provider All Other Providers • Outpatient Facility Services No Copayment, Deductible, or Coinsurance 50% Coinsurance after Deductible These charges will NOT apply to your Out- of-Pocket Limit. Donor Health Service Limit For Human Organ and Tissue Transplants, Medically Necessary charges for getting an organ from a live donor are covered up to our Maximum Allowed Amount, including complications from the donor procedure for up to six weeks from the date of procurement.