Hip, Knee, and Spine Inpatient Surgical Benefit Change
Effective October 1, 2015, the Blue Distinction Pus program was implemented for inpatient hip and knee replacements and spine procedures. Members considering these types of procedures must contact member services at 661-327-7581 to obtain information regarding in-network facilities for the requested procedure. A travel benefit will be available for those who do not have access to a covered facility in their area.
X-Ray & Lab, Durable Medical Equipment, and Physical Medicine – Out of Network Benefit Change
Removing fraud, waste and abuse (FW&A) from the system is a challenge all health plans face. Over the last few years, the FW&A continues to reoccur in the same categories - X-Ray & Lab, Physical Medicine and Durable Medical Equipment. As a result, out of network coverage for these services has been eliminated effective October 1, 2015. Physical Medicine includes chiropractic, physical and occupational therapy. In instances where there is no access to a contracting provider in one of these categories, member services can assist with an authorized referral to a non-participating provider prior to services being rendered. This change does not apply to emergencies.
Diabetic Test Strips – Benefit Change
As of October 1, 2015, SISC will have preferred diabetic test strips from Abbott (Freestyle) and Lifescan (One Touch) available at the generic co-pay. All other test strips will be covered at the brand co- pay. If a physician prescribes a preferred test strip, a new meter will be provided at no cost. Any questions can be directed to Navitus member services at 1-866-333-2757.