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Prosthetic or Orthotic Devices Covered services include the purchase and initial placement of prosthetic or orthotic devices, and the fitting, repair, or replacement when medically necessary. No shoe build-up, shoe orthotic, shoe brace, or shoe support is covered unless the shoe is attached to a brace.

Sleep Disorders Services and supplies for the diagnosis and treatment of Obstructive Sleep Apnea Syndrome (OSAS) or other sleep disorders must be received in a sleep disorder center or laboratory, either affiliated with a hospital or freestanding, which is accredited by the American Academy of Sleep Medicine (AASM). Participants can contact Blue Cross & Blue Shield to locate an accredited facility. The interpretation of all sleep tests must be performed by a physician who is board certified as a sleep specialist by the American Board of Sleep Medicine.

Speech Therapy Speech therapy services are covered if needed as the result of an illness or injury, there is a reasonable expectation that the therapy will achieve measurable improvement within a reasonable and predictable period, and services are prescribed by a physician and provided by a licensed speech therapist.

Speech therapy is not covered for maintenance speech, delayed language development, articulation disorders, learning disabilities, attention disorders, psychosocial speech delay, behavioral problems, conceptual handicap, mental retardation, stammering, or stuttering.

Substance Abuse All inpatient hospital admissions for substance abuse treatment must be certified as medically necessary by Intracorp.

The following services are covered, provided the treatment is considered medically necessary:

  • Inpatient stabilization services or intensive outpatient hospital programs associated with a hospital (inpatient rehabilitative services after stabilization/detoxification is achieved are not covered)

  • Outpatient substance abuse treatment

The combined benefit for inpatient and outpatient substance abuse treatment is limited to $8,000 per calendar year and a lifetime maximum of $16,000 per participant.

Substance abuse services provided in a residential facility are not covered.

Temporal Mandibular Joint Syndrome (TMJ) Benefits for surgery and diagnostic services of the temporomandibular/craniomandibular joint are provided, up to a lifetime maximum benefit of $5,000. Benefits are not provided for physical therapy, orthodontics, dentures, occlusional reconstruction, or for crowns or inlays.

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