Distributed Context
Create questions where the answer involves synthesizing data from several non-adjacent sections.
Question
| “What coverage do you offer for chemotherapy?” |
Answer
|
“1. **Intravenous Chemotherapy**: - Chemotherapy received on an outpatient basis at a hospital or alternate facility is covered. This includes the facility charge, and the charge for required services, supplies, and equipment. Benefits for facility-based physician's fees related to these services are described under Physician Fees for Surgical and Medical Services. 2. **Outpatient Therapeutic Services**: - Intravenous chemotherapy or other intravenous infusion therapy is covered under outpatient therapeutic services. Prior authorization is required for these services. 3. **Outpatient Surgery, Diagnostic, and Therapeutic Services**: - Cancer chemotherapy and intravenous infusion therapy are included under other diagnostic tests and therapeutic treatments received on an outpatient basis at a hospital or alternate facility. 4. **Wigs**: - Coverage is available for wigs prescribed by a physician when hair loss is the result of chemotherapy and radiation treatment for cancer. The benefit for wigs is limited to a maximum of $500 of billed charges per diagnosis. 5. **Acupuncture**: - Acupuncture is covered when used for the treatment of nausea resulting from chemotherapy. |
Excerpts from the Source Document:
Under the Covered Health Services heading:
Page 61 explains outpatient chemotherapy is covered.
|
OUTPATIENT THERAPEUTIC IMPORTANT: Prior Authorization is required. The Plan pays for Covered Health Services for therapeutic treatments received on an outpatient basis at a Hospital or Alternate Facility, including dialysis (both hemodialysis and peritoneal dialysis), intravenous chemotherapy or other intravenous infusion therapy, and other treatments not listed above. Benefits under this section include the facility charge, and the charge for required services, supplies and equipment. Benefits for facility-based Physician's fees related to these services are described under Physician Fees for Surgical and Medical Services. When these services are performed in a Physician's office, benefits are described under Physician's Office Services. |
Page 80 includes information about coverage for wigs when hair loss is the result of chemotherapy:
|
Wigs Coverage is available for wigs prescribed by a Physician when the hair loss is the result of a medical condition (such as chemotherapy and radiation treatment for cancer). The benefit for wigs is limited to a maximum of $500 of billed charges per diagnosis, regardless of the network status of the Provider. Please note that Network Deductibles and Coinsurance apply to a Non-Network Provider when a Network Provider is not available. |
Page 38 includes information about acupuncture for the treatment of nausea resulting from chemotherapy:
|
Acupuncture Acupuncture is a Covered Health Service when services are provided by an Acupuncturist who is practicing within the scope of his or her license or certification and the laws of jurisdiction when used for the treatment of:
Maintenance Acupuncture is not a Covered Health Service. See Exclusions. |
Page 47 explains that cover for fertility preservation is available for medical reasons that cause irreversible infertility such as chemotherapy:
|
FERTILITY PRESERVATION FOR IATROGENIC INFERTILITY Benefits are available for fertility preservation for medical reasons that cause irreversible infertility such as chemotherapy, radiation treatment, and bilateral oophorectomy due to cancer. Services include the following procedures, when provided by or under the care or supervision of a Physician:
Benefits are not available for long-term storage costs (greater than one year). |
The information to answer this question completely is spread across several different sections in the policy document. The Oracle Fusion AI Agent must first retrieve all the relevant information before synthesizing the content into a comprehensive, cogent answer.