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Private insurance policy information

Below are links to many of the BlueCross and/or BlueShield (BCBS) and other large commercial medical coverage policy web sites. To locate policies, use the search function and search for specific terms (e.g. microprocessor, myo, prosthetic, prosthesis, AFO, brace, wheelchair, seating, stander, etc.) into the search function.

Note: These policies may not apply to all lines of business such as the Federal Employee Program, Medicare Advantage, and certain self-insured groups. Additionally, definition of the terms “medical necessity” and “investigational” may vary from plan to plan.

The product/device “Supplier” (defined as an O&P practitioner, O&P patient care facility, or DME Supplier) assumes full responsibility for accurate billing of Ottobock products. It is the Supplier’s responsibility to determine medical necessity; ensure coverage criteria is met; and submit appropriate HCPCS codes, modifiers, and charges for services/products delivered. It is also recommended that Supplier’s contact insurance payer(s) for coding and coverage guidance prior to submitting claims. Ottobock Coding Suggestions and Reimbursement Guides are based on reasonable judgment and are not recommended to replace the Supplier’s judgment. These recommendations may be subject to revision based on additional information or alpha-numeric system changes.


Aetna

AL BCBS

AmeriHealth

Anthem BCBS  (CA, CO, CN, CT, GA, IN, KY, ME, MO, NV, NH, OH, WI, VA; Empire BCBS NY, NJ & CT) Search Medical Policies & Utilization Management

AR BCBS

AZ BCBS

BCBS National Association (contains links to all BCBS organizations)

CA BlueShield

CareFirst_BCBS (MD, ND, VA, DC)

Cigna

FL _BCBS

GA_BCBS

HMSA (BCBS Hawaii)

HCSC (BCBS IL, NM, TX, & OK)

Health Net

Humana

ID BlueCross

MA_BCBS

MN_BCBS

MS BCBS

NC BCBS

ND_BCBS

NY Western BCBS

NY Northeastern BlueShield

NY Excellus BCBS (Central NY, Utica-Watertown, NY Rochester)

PA_Capital_BlueCross

PA_(Southeastern)-Independence_BlueCross

PA_(Northeastern)_Wilkes_Barre_BlueCross

Premera (WA, AK)_BlueCross

Regence_BlueShield_(WA, OR, UT, ID)

SC_BCBS

TN BCBS

VT_BCBS

Wellmark_BCBS (SD & IA)

United HealthCare (Document Title – “Specialized Microprocessor or Myoelectric Limb”)