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[IP] Re: Insurance Questions -- Michael

I just got the new book for my Blue Cross Blue Shield of Michigan PPO Plan.
It says that "Durable Medical Equipment":

"...is covered when prescribed by your physician, and received from a
contracted supplier.  The equipment must be medically necessary for the
treatment of an illness or injury, or used to improve the function of the
patient's body.  Equipment can be rented or purchased, whichever is less

There are other statements regarding the definition of "Medical Necessity",
but it does state that "Medical Necessity is determined by physicians acting
for Blue Cross Blue Shield.  It is based on criteria and guidelines
developed for Blue Cross and Blue Shield by physicians acting for their
respective provider types."  It goes on to say that the covered service must
be accepted as necessary and appropriate for the patient's condition and not
mainly for the convenience of the patient or physician.

So.... I take this to mean, that Blue Cross Blue Shield has physicans who
can make the determination whether the Durable Medical Equipment is
medically necessary regardless of what my own doctor says.  They claim to
have guidelines.  Hope that doesn't hurt my chances for approval, which I'm
still waiting for........


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