| HMO | Pulmonary Therapy |
| Aetna US Healthcare | Covers: Pulmonary rehabilitation as part of an inpatient hospital stay. |
| Blue Cross Blue Shield | Covers: Outpatient short-term respiratory services for conditions which are expected to show significant improvement through short-term therapy, as determined by the PCP.
Limits: Limited to a maximum of 30 visits per calendar year. Cost Sharing: Copayment applies. |
| CIGNA / Healthsource | Covers: Respiratory therapy as well as oxygen and nebulizer usage both inpatient and home health. |
| Doctors Health Plan | Covered. |
| Generations | Covers: Inhalation therapy. |
| Optimum Choice | Covered. |
| PARTNERS | Covers: Necessary pulmonary rehabilitation when prior approved by plan.
Limits: Limited to one course of treatment for 3 consecutive months per lifetime when approved by plan. Note: Limit does not apply to patients who have undergone a lung transplant. Covers inpatient rehabilitation therapy if under supervision of physician and supported by plan-approved treatment plan. |
| Coventry/Principal Health Care of the Carolinas | Covers: short-term pulmonary therapy.
Limits: Therapy is limited to conditions that are expected to show significant improvement in 60 days. Benefits for therapy and/or treatment will be discontinued if it is determined within the first two weeks that the member’s condition will not significantly improve. |
| QualChoice | Covered. |
| The Wellness Plan of North Carolina, Inc. | Excluded. |
| United HealthCare | Covers: Short-term speech therapy provided under the direction of a participating provider.
Limits: Limited to 20 visits per member per calendar year. Requires prior approval. Inpatient services are covered under the medical inpatient benefits. Cost Sharing: Copayments may apply. Excludes: Speech therapy for children of school age as these services must be provided through the school system. |
| WellPath | Covers: Inhalation therapy administered in physician’s office or as part of inpatient care. Medically necessary pulmonary rehabilitation, subject to precertification by WellPath.
Cost Sharing: Included in applicable office visit copayment. Excludes: Therapy that could be administered or applied at home or by someone who is not a physician. |