Benefit coverage exclusions

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This list below includes many of the services or categories of services that are not covered (excluded) by most plans for a variety of reasons. These reasons include, but are not limited to, services that are not medically necessary, services that are experimental or investigative, or services that are covered by the government.  For a complete list of covered benefits and exclusions, please refer to your plan benefits by logging in to your Member Home page, checking your subscriber agreement/benefit booklet, or contacting Customer Service.

The following services are covered either partially, or not at all, by Blue Cross:

  • Acupuncture unless covered by a rider or plan design;
  • Autism unless covered by plan design;
  • Charges for blood or drawing, processing, or storage of your own blood;
  • Charges for missed appointments;
  • Completion of claim forms or other administrative charges;
  • Cosmetic procedures except as required by the Women's Health and Cancer Rights Act and Rhode Island law for breast reconstruction following mastectomy;
  • Deductible and copayments;
  • Dental services (Certain limitations apply.);
  • Employment-related injuries;
  • Experimental or investigational services except as required by Rhode Island laws;
  • Extra charges for a private hospital room;
  • Eye exercises and visual training;
  • Eyeglasses for adults unless covered by a rider or plan design;
  • Food or food products, whether or not prescribed except as required by Rhode Island laws;
  • Freezing and storage of blood, sperm, gametes, embryos, or other tissues;
  • Gene therapy and parentage testing;
  • Hearing aids except as required by Rhode Island law, or as covered by a rider;
  • Home­making, companion care, custodial care, day care, or respite care;
  • Illegal drugs;
  • Infant formula, whether or not prescribed except as required by Rhode Island law;
  • Long-term care facilities;
  • Marital counseling;
  • Methadone or other drug maintenance treatment for treating chronic addiction;
  • Personal appearance items or personal comfort items;
  • Recreational therapy, mas­sage therapy, aqua therapy, maintenance therapy, aromatherapy, or biofeedback training;
  • Research studies;
  • Reversal of voluntary sterilization or infertility treatment for an individual that previously had a voluntary sterilization procedure;
  • Routine foot care;
  • Services covered by the government or other sources;
  • Services of Christian Scientist Practitioners;
  • Services of natu­ropaths and homeopaths;
  • Services performed by people or facilities not legally qualified or licensed;
  • Services performed by facilities we have not approved;
  • Services provided by colleges or school health facilities;
  • Services related to surrogate parenting or newborn children of surrogate parents;
  • Services related to employment, education, marriage, adoption, travel, or insurance purposes or when required by similar third parties;
  • Services that are not medi­cally necessary;
  • Services that are not listed in the subscriber agreement/benefit booklet as covered health­care services;
  • Sex transformations or sex therapy, unless covered by plan design;
  • Smoking cessation treatment, except as required by Rhode Island laws and the Affordable Care Act;
  • Telephone consultations; and
  • Weight-loss programs other than preventive obesity screening and counseling services required by the Affordable Care Act.

NOTE: This is a summary of the services that are covered either partially, or not at all, by Blue Cross. It is not a contract. For details about your coverage, including any limitations or exclusions not noted here, please refer to your subscriber agreement/benefit booklet.

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