definition: medical implant

[Guest bayarea1]

Can anyone direct me to a credible source for a definition of 'medical implant' (i.e., pacemaker)? The health plan in question has weak definitions and we are having difficulty with a provider who is upcoding to take advantage of a paid-in-full benefit.

[Moe Howard]

Sorry I don't have a written source to give you .... but medical science usually separartes types of medical implants into two categories.

1. Those that penetrate and have a physiologic interaction with living tissue.

2. Those that penetrate but do not have a physiologic interaction with living tissue.

Keep in mind that federal courts (if your plan is an ERISA plan) usually construe an ambiguous definition by the plan ... to be aganist the Plan.

Your plan document/ policy should have done a better job in defining exactly what it means by "medical implant".