Does insurnce cover Family planning services - SHP insurance

Family Planning Services - Family Planning Services include education, information, referral,
counseling, diagnostic procedures and contraceptive drugs and supplies. Members have freedom of choice in choosing a contraceptive method and the services are voluntary.

* These services may not be provided to members under 18 unless one of the following is met:

* The member is a parent, pregnant or married, has written consent by a parent or legal guardian,
or in the opinion of a physician, the plan participant may suffer health hazards if services are not
provided.
*  The Family Planning Services Program does not include sterilization. Members can go to any
provider that participates with Medicaid, including the County Health Department, for these
services without a referral from the PCP.

A provider may refuse to furnish any contraceptive or family planning service, supplies, or information for medical or religious reasons and the provider shall not be held liable for such refusal. Please call SHP for assistance in referring the member to another provider.

-If a member receives Family Planning services from a non-participating provider, SHP will reimburse the provider at the Medicaid reimbursement rate.

Abortion - An abortion may be performed when the life of the mother would be endangered if the fetus were carried to term; this must be documented in the medical record by the attending physician stating the reason for the necessity of the abortion, or if the pregnancy is the result of rape or incest. Abortions must be documented with a completed Abortion Certification Form

Hysterectomy – is covered when is non-elective and medically necessary and must meet the following requirements:

*  The member or her representative must have been informed verbally and in writing that the
hysterectomy will render her incapable of reproduction permanently.
*  The member or her representative has signed and been given a copy of the Acknowledgment of
Receipt of Hysterectomy Information form (Refer to the Forms Section of the handbook) or an

Exception
Form to this requirement.

*  Hysterectomies are not reimbursable when performed for the sole purpose of rendering a
recipient permanently sterile or incapable of reproducing. Hysterectomy procedures must meet
specific requirements before payment


1 comment:

Tara Claims said...

It's so sad that not more attention is brought to this issue - if we simply had the support in the community, there would be fewer unwanted pregnancies and therefore fewer abortions.

Medical Billing Popular Articles