![]() ![]() Stereotactic Radiosurgery Using Gamma Rays (6.01.043).Skilled nursing facility admissions (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care).Proton Beam Radiation Therapy (6.01.019).Private Duty Nursing (Criteria defined in the employer group benefit contract).Pre-implantation Genetic Testing (4.02.007).Out-of-network services (Benefits available according to the member contract).Maternity Services - inpatient only, for stay greater than 48/96 hours (Criteria defined in the employer group benefit contract).Intravenous Immune Globulin (IVIG) Therapy (5.01.013).Inpatient rehabilitation (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care).Hospice (Criteria defined in the employer group benefit contract).Home Infusion Therapy (Criteria defined in the employer group benefit contract).Home health care (Criteria defined in the employer group benefit contract).General anesthesia for dental care (9.01.007A).FEP – Medications requiring online prior authorization.Durable Medical Equipment over specified dollar amounts (varies). ![]()
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