Exclusions

  • All costs associated with the collection and preservation of sperm for artificial insemination.
  • Allergy testing and immunotherapy.
  • Alternative and holistic health care services.
  • Ambulance Services.
  • Amniocentesis.
  • Any medical service provided or received outside of Palm Beach County will not be considered for reimbursement by the Health Care District of Palm Beach County unless authorized by the Health Care District.
  • Any patient treated in a hospital while under arrest by, in custody of, being guarded by a law enforcement officer, or under house arrest (as an outcome of incarceration and/or sentencing).
  • Any service provided or received without having been prescribed, directed or authorized by the Health Care District.
  • Any services in connection with education and treatment for learning or developmental disabilities.
  • Bone Stimulators.
  • Cardiac rehabilitation.
  • Care or treatment of anorexia nerova or bulimia.
  • Chelation therapy.
  • Chiropractic treatment or services.
  • Complications related to non-covered services.
  • Cosmetic, medical, surgical, and non-surgical treatments and procedures provided primarily for cosmetic purposes, which shall include but are not limited to: (1) surgery to the upper and lower eyelid; (2) penile implant; (3) augmentation mammoplasty; (4) reduction mammoplasty for male or female or other cosmetic procedures to the breast, (5) removal of breast implants, except in post mastectomy surgery; (6) full or partial face lift; (7) dermabrasion or chemical exfoliation; (8) scar revision,(9) otoplasty; (10) surgical lift, stretch, or reduction of the abdomen, buttocks, thighs, or upper arm; (11) silicone injections to any part of the body; (12) rhinoplasty; (13) hair transplant; and (14) tattoo removal.
  • Cost of services performed by another institutional facility while you are hospitalized in a facility.
  • Custodial, domiciliary, convalescent or rest care and care in a skilled nursing facility.
  • Dental: All dental services provided outside the C. L. Brumback Primary Care Clinic, including but not limited to orthodontic services or procedures, endodontic procedures, periodontal surgery, cast crowns, cast post or core, cast bridges, inlays or onlays, porcelain or resin laminate veneers, space maintainers, implants, or any cosmetic dental procedures.
  • Diabetic shoes, diabetic shoe inserts or any item related to diabetic footwear.
  • Dialysis for chronic renal failure after the 90th day of treatment from first day of dialysis treatment; dialysis treatments within the home.
  • ECP (External Counterpulsation).
  • Experimental medical, surgical or psychiatric procedures and pharmacological regimes that are not generally accepted by the medical community or the Health Care District.
  • External defibrillator vest.
  • Eye glasses or contact lenses.
  • Fertility or infertility testing, artificial insemination or invitro fertilization, embryo transplantation, human chronic gonadotropin (HCG) injections or reversal of sterilization procedure.
  • Foot care, such as removal of warts, corns, or calluses, including, but not limited to, podiatric treatment of bunions, toenails, flat feet, fallen arches, hammertoes, and chronic foot strain.
  • Gastric stapling, gastric bypass, gastric banding, and other surgical experimental or investigational procedures for the treatment of obesity, weight loss and/or weight management. Diet programs and any variants thereof or exercise programs.
  • Genetic testing, counseling and other related services.
  • Health or beauty aids, or hair analysis.
  • Hearing aids.
  • Immunizations required for travel and physical examinations needed for employment, insurance, or governmental licensing.
  • Joint replacements.
  • Medical or rehabilitation services related to the abuse of or addiction to alcohol, drugs, or other substances. 
  • Mental or Behavioral Health services including any services related to the abuse of alcohol, drugs, or other substances are limited to the services provided by C.L. Brumback Primary Care Clinic.
  • Orthotics (except for joint immobilization).
  • Pain management.
  • Pharmaceuticals when a patient assistance program is available.
  • Private duty nursing services.
  • Prosthetics - limit one (1) prosthetic per limb per lifetime.
  • Repair, replacement or revision of prosthetics, implants or hardware.
  • Repair, replacement or revision of DME.
  • Sclera therapy.
  • Services associated with aiding a patient in the home, such as homemaker, domestic or maid service.
  • Services in connection with long term care, chronic care, or nursing home care are limited to the services provided by Edward J. Healey Rehabilitation and Nursing Center.
  • Services provided by a family member.
  • Services provided in a hospital setting when the member leaves against medical advice (AMA).
  • Services received as a result of an illegal act. Any injury resulted from being arrested by, in custody of, being guarded by a law enforcement officer or under house arrest (as an outcome of incarceration and/or sentencing).
  • Services received prior to your eligibility effective date or after the termination date.
  • Sex change operations or any sex change related services including services for sexual transformation or sexual dysfunction or inadequacies.
  • Suicide, attempted suicide, or self-inflicted injury.
  • Therapies such as occupational, physical, and/or speech, unless prescribed by a physician and as it relates to a medical condition.
  • Transplants and any related service to transplants, including transplant donor expenses, or stem cell transplant.
  • Transportation- Bus passes are available by the C.L. Brumback Primary Care Clinic.
  • Travel, whether or not recommended by a physician.
  • Treatment and/or repair of chronic congenital abnormalities.
  • Treatment for acne or non symptomatic lesions, which may include but are not limited to warts, moles, nevi, lipomas, or cysts.
  • Treatment for conditions covered by Workers’ Compensation laws.
  • Treatment for military service-connected disabilities for which the Veterans Administration and military hospital system provides care to which the member is legally entitled and when such facilities are reasonably available within the service area.
  • Treatment of Temporomandibular Joint Disease (TMJ).
  • Treatment of varicose veins of the extremities.
  • Unattended sleep studies.
  • Urgent care clinic services.
  • Vision training, eye exercises, orthoptics, or surgery performed primarily to correct or improve myopia, presbyopia or astigmatism.
  • Wound VAC.

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