Meredith completes running assessments in the clinic using video analysis to diagnose and manage chronic running injuries. No verbal statementcan modify or otherwise affect the benefits, limitations, and exclusions of this brochure. Contact us at the customer service phone number on the back of your ID card for information or to request prior approval before obtaining services. We cover routine nursery care of the newborn when performed during the covered portion of the mothers maternity stay and billed by the facility. Jayden is passionate about treating patients for all types of foot, ankle, calf, and shin pain, particularly bone and joint, soft tissue, and muscular pathologies. Outside of work, Josh enjoys surfing and many other sports. Since graduating Ashlyn has relocated to the beautiful Sunshine Coast. The NON-CORE benefits are there to provide coverage for any unexpected medical costs you may incur during the calendar year. Tim is available for Physiotherapy appointments at our Springfield clinic. You can find additional information at www.opm.gov/healthcare-insurance. A suggested protocol would include adjustments at 24 hrs, 3 days, 7 days, 14 days, 21 days, and 1 month. I feel thisgives people the tools to be the driver of their recovery. We are talking about getting help from your bodys own potential to heal itself. Once the cause of occlusal-related disorders is identified, this reversible, noninvasive therapy provides both diagnostic information and relief without the problems that often accompany other approaches to care, ie, surgery and extended drug therapy. Soft rubber splints and hydrostatic splints (Aqualizer, Jumar Corp) function by separating the teeth. You will then have up to 48 hours to provide the required information. In the case of a pre-service claim and subject to a request for additional information, we have 30 days from the date we receive your written request for reconsideration to: You or your provider must send the information so that we receive it within 60 days of our request. Kelly has a keen interest in mindfulness and the benefits of exercise on mental health and well-being and likes to explore this in her approach to Physiotherapy management. This applies to a combined total for medical and mental health and substance use disorder visits. Do not give your plan identification (ID) number over the phone or to people you do not know, except for your healthcare provider, authorized health benefits plan, or OPM representative. She started the The Hand Therapy Clinic within Sports & Spinal Physiotherapy at her clinic in Sippy Downs and has been training her colleagues and new graduate staff in the optimal treatment of the shoulder, elbow, wrist & hand. Hospital services are listed in Section 5(c) and Surgical benefits are in Section 5(b). Discount Drug Program The Discount Drug Program is available to members at no additional premium cost. Likewise, swimmers ear(otitis externa, an infection in the outer part of your ear) can also lead to ear pressure when water is trapped in their ear. Please note that the requirements to obtain precertification for inpatient care and prior approval for those services listed in Section 3 do not apply when you receive care overseas, with the exception of admissions for gender reassignment surgery (see page 19 for information) and admissions to residential treatment centers. He also loves travelling and exploring the world! Emily is available for Womens Health Physiotherapy appointments at our Maroochydore, Sippy Downs, and Buderim locations. He enjoys boating, fishing and golfing in his spare time. In her spare time, you can find Naomi getting lost in a book, surfing, or trying out a new restaurant. All benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine that the criteria for medical necessity are met. As well as this, Belinda is a full member of Exercise and Sport Science Australia (ESSA). You can choose your own physicians, hospitals, and other healthcare providers within our Preferred Provider Organization (PPO) network. She is determined to get people to their optimal level of function so they can get back to what they love and enjoy doing pain-free. In his spare time, Rod enjoys surfing, swimming, running, and AFL Umpiring. Outside of work, Emily is passionate about health and fitness and will regularly be found in the gym or eating at one of QLDs best restaurants. Yes, RSV Can Spread to Adults From KidsHeres Why That Matters Right Now. Rod is also experienced in reflexology and pregnancy massage. The physiology of splint therapy: a literature review. Jordan graduated from James Cook University in Townsville in 2017 with a bachelor of Clinical Exercise Physiology. If you are divorced from a Federal employee or annuitant you may not continue to get benefits under your former spouses enrollment. Laura graduated with a Bachelor of Physiotherapy at the University of South Australia, and since then has been working in rehabilitation centres and private practice. Jaydens priority is to enable people of all ages to maintain an active lifestyle and deliver tailored treatment solutions based on individual goals. Relevant Links: Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. FEP Blue Focus Benefits (FEP Blue Focus) Section 5. Only eligible expenses for Preferred provider services count toward these limits. 16. Simon has over 20 years of experience as a physiotherapy clinician, educator, and clinic owner. Ray believes in a holistic approach to a persons health and well-being, so she uses a combination of remedial and relaxation techniques during a typical massage treatment, including Trigger Point Therapy, Myofascial Release, and Deep Tissue Massage. Marina has completed a Bachelor of Physiotherapy and Bachelors degree in Exercise Science with first-class honours. Growing up, Annaliese admired how her grandmother, who has 52 years of experience as a physiotherapist, was able to use her knowledge and skills to help others. Tim is available for Physiotherapy appointments at our Beenleigh clinic. THIS INCLUDES ICBC AND WCB. Any surgical procedure or any portion of a procedure performed primarily to improve physical appearance through change in bodily form, except for repair of accidental injury, or to restore or correct a part of the body that has been altered as a result of disease or surgery or to correct a congenital anomaly. FEDVIP coverage pays secondary to that coverage. If you want more information about us, call or write to us. We use the Department of Veterans Affairs (VA) Medicare-equivalent Remittance Advice (MRA) when the MRA statement is submitted to determine our payment for covered services provided to you if Medicare is primary, when Medicare does not pay the VA facility. J Craniomandib Disord. Koren is available for Physiotherapy appointments at our Coolumlocation. Her treatment approach involves exercise prescription, soft tissue mobilization/myofascial release, patient education, and correction of posture and movement patterns. Ray has always been involved with coordinating playgroups, mothers groups, kindy committees, and school committees to give them a sense of community and show them how important it is to be involved in social networks. Sally is a senior Accredited Practising Dietitian with over 30 years of experience as a Clinical Dietitian, having worked in both the Public and Private sectors. You can also obtain the list and forms through our website at www.fepblue.org. If your physician has recommended you receive a transplant or that you participate in a transplant clinical trial, we encourage you to contact the Case Management Department at your Local Plan. Unless otherwise noted, the benefits listed above and on pages 41-42 do not apply to children up to age 22. 1994;8:178-189. Jarrods passion is driven through the enjoyment of improving the lives of those living with comorbidities through personably tailored and evidence-based exercise prescriptions. He believes everyone wanting their bodies to stay healthy should see a massage therapist for maintaining proper body movement patterning. Benefits for gender reassignment surgery are limited to once per covered procedure, per lifetime. ), For Self Only contracts, your catastrophic out-of-pocket maximum is now $8,500. Sally has extensive experience in private practice having built a large private practice on the Sunshine Coast over the past 25 years. Boero RP. Emily can treat and assist in pre and post-natal management, prolapse, urinary incontinence, bladder concerns, and rehabilitation support for urogynaecological surgeries. Services or supplies for which no charge would be made if the covered individual had no health insurance coverage. In her spare time, she enjoys playing a variety of sports including tennis, basketball and badminton and travelling the globe. In addition to ear pressure, symptoms could include sharp ear pain that subsides quickly, drainage, tinnitus(ringing in your ears) or hearing loss. ), or down at the beach, which is why I moved to the beautiful Sunshine Coast! Outside of work, Sarah enjoys roller skating, spending time with family and friends and taking her two German Shepards for a walk. Edward is available for appointments at our Maroochydore location. A condition that existed at or from birth and is a significant deviation from the common form or norm. Benefits are limited to the stages of the diagnoses listed. See page 62 for the prior approval and facility transplant program requirements that apply to blood or marrow stem cell transplants. Ed is available for Physiotherapy appointments at the Caloundra clinic. For example: For more information on NAIC rules regarding the coordinating of benefits, visit our website at www.fepblue.org/coordinationofbenefits. He has a keen interest in sporting injuries since working with elite athletes from a range of sports. Jarrod graduated from QUT with a Bachelors degree in Clinical Exercise Physiology and with a strong passion for treating a wide range of conditions, especially musculoskeletal conditions. This has been to her patients benefit as she has run and managed Pilates mat work classes for 6 years. We cover up to 4 visits per year in full to treat depression associated with pregnancy under maternity benefits (i.e., depression during pregnancy, postpartum depression, or both) when you use a Preferred provider. She regularly attends further training to ensure that her clinical skills and knowledge are kept up to date. Your Costs for Covered Services, Non-FEHB Benefits Available to Plan Members, Section 6. Curtis DA, Nielsen I, Kapila S, et al. As an avid soccer player, her interest was sparked by the care and support she herself received from physiotherapists for injuries she sustained on the soccer field. Caitlyn has additional experience having been a Sports Trainer for the Pine Rivers Netball Association. Coen enjoys fishing, going to the beach, playing soccer, and spending time with friends and family outside of work. Acupuncture needles are left in place for 15-30 minutes, Book Bodywork Massage (Non-Registered Massage Therapy) by Practitioner, Book Bodywork Massage (Non-Registered Massage Therapy) by Treatment, Book Kinesiology - Active Rehab by Practitioner, Book Kinesiology - Active Rehab by Treatment, Book Telehealth Kinesiology /Active Rehab by Practitioner, Book Telehealth Kinesiology /Active Rehab by Treatment, Create a gift card code you can send to a friend or loved one for products or services at, Bodywork Massage (Non-Registered Massage Therapy). Services you receive from a provider that are outside the scope of the providers licensure or certification. Craig is available for Podiatry appointments at our Hervey Bay clinic. See page 72 for our coverage of acupuncture when provided as anesthesia for covered maternity care. If you fail to provide sufficient information, we will contact you within 24 hours after we receive the claim to let you know what information we need to complete our review of the claim. TMJ Assessment and Management 30 minutes - $95.00 - Offered by A foot orthotic supports, aligns, prevents or corrects mal-alignments and improves functions of the foot. For inpatient stays resulting from medical emergencies or accidental injuries, or for emergency deliveries, our allowance is the lesser of the billed amount or the qualifying payment amount (QPA) determined in accordance with federal laws and regulations; For outpatient services resulting from a medical emergency or accidental injury that are billed by Non-member facilities, our allowance is the lesser of the billed amount or the qualifying payment amount (QPA) determined in accordance with federal laws and regulations (minus any amount for noncovered services); For physicians and other covered healthcare professionals that do not contract with your local Blue Cross and Blue Shield Plan, our allowance is equal to the greater of (1) the Medicare participating fee schedule amount or the Medicare Part B Drug Average Sale Price (ASP) for the service, drug, or supply in the geographic area in which it was performed or obtained or (2) 100% of the Local Plan Allowance. Destiny joined our team in July 2021 and held an associate membership with Massage and Myotherapy Australia. Holly graduated with a Bachelor of Physiotherapy from James Cook University in Townsville. Kelly has a specialist interest in shoulder and upper limb rehabilitation, with prior experience establishing an advanced level rehabilitation class, with the aim of returning individuals to sports and manual occupations. For example, we do not determine whether you or a dependent is covered under this Plan. when billed by a provider other than the urgent care center are stated in Section 5(a), page 53. Kimberley is interested in musculoskeletal, neurological and sports physiotherapy. We will help you find replacement coverage inside or outside the Marketplace. Limits of human bite strength. If you have a pre-service claim and you do not agree with our decision regarding precertificationof an inpatient admission or prior approval of Other services, you may request a review by following the procedures listed on the next page. If you remain in the hospital beyond the number of days we approved and did not get the additional days precertified, then: If your residential treatment centerstay needs to be extended, you, your representative, your physician or the residential treatment center must ask us to approve the additional days. Professional charges for after-hours care, except when associated with services provided in a physician's office. Hekneby M. The load of the temporomandibular joint: physical calculations and analysis. Note: This benefit is available only through the contracted telehealth provider network. She has a developing interest in mental health and metabolic conditions whereby when completing her degree wrote a paper for her thesis on the benefits of exercise on mental health. See page 71 for maternity care provided in an outpatient facility. Maternity care benefits are not provided for prescription drugs required during pregnancy, except as recommended under the Affordable Care Act. Faith is motivated to optimise the quality of life for all that come to see her, ensuring sessions and programs address personal goals, current ability and lifestyles. A surprise bill is an unexpected bill you receive from a Non-participating healthcare provider, facility, or air ambulance service for healthcare. If you have not yet received your ID card, you can contact your Local Plan at the phone number listed in your local phone directory. Carolyn is one of our Remedial Massage Therapists. Individual plans may vary. Balancing body composition goals and training recovery, Junior sports nutrition and everyday eating. A Carriers pursuit of a recovery if a covered individual has suffered an illness or injury and has received, in connection with that illness or injury, a payment from any party that may be liable, any applicable insurance policy, or a workers compensation program or insurance policy, and the terms of the Carriers health benefits plan require the covered individual, as a result of such payment, to reimburse the Carrier out of the payment to the extent of the benefits initially paid or provided. OTC pain relievers: Take an over-the-counter pain reliever like ibuprofen or acetaminophen. Each Local Plan contracts with hospitals and other healthcare facilities, physicians, and other healthcare professionals in its service area, and is responsible for processing and paying claims for services you receive within that area. Tim is particularly passionate about running biomechanics and footwear advice/prescription, a special interest that commenced through his strong interest in athletics and involvement in the footwear industry. Nigel is finalising his studies for his PhD thesis investigating hamstring injuries in AFL players and has published some of this research. Filing a Claim for Covered Services, Section 9. We limit our payment to an amount that supplements the benefits that Medicare would pay under Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), regardless of whether Medicare pays. Section 5(a). Medical University, Chennai, India and later went on to pursue his Post Graduate Diploma in Developmental rehabilitation, from Osmania University. Tim Dunstone gained his initial physiotherapy qualification in Adelaide from the renowned School of Physiotherapy at the University of South Australia. Cara has also undergone further study for the treatment of Lymphoedema and is a qualified Australasian Lymphology Accredited Lymphoedema Practitioner. Professional care provided at Preferred facilities by Non-preferred radiologists, anesthesiologists, certified registered nurse anesthetists (CRNAs), pathologists, emergency room physicians, and assistant surgeons; Laboratory and pathology services, X-rays, and diagnostic tests billed by Non-preferred laboratories, radiologists, and outpatient facilities; Care received outside the United States, Puerto Rico, and the U.S. Virgin Islands; or. She has completed 2750 hours of course, which included time at a seniors facility, which she very much enjoyed. Elise graduated with a Bachelor of Clinical Exercise Physiology at the Queensland University of Technology. Cielo is passionate about using a holistic approach to help people get back on their feet and achieve their goals, whether to improve daily function, return to recreational or competitive sports and or optimise general health and well-being. While gender reassignment surgeons (benefit details found in Section 5(b)) and hormone therapy providers (benefit details found in Section 5(f)) play important roles in preventive care, you should see a primary care provider familiar with your overall healthcare needs. Ashleigh is available for Physiotherapy appointments at our Chermside clinic. We may revoke the alternative benefits agreement immediately at any time, if we discover we were misled by the information given to us by you, your provider, or anyone else involved in your care, or that you are not meeting the terms of the agreement. We have a Preferred Provider Organization (PPO), How we pay professional and facility providers, Your medical and claims records are confidential, Section 4. You are not responsible for any charges greater than the equivalent Medicare amount; we will show that amount on the explanation of benefits (EOB) form that we send you. Osteopathic manipulative treatment to any body region, Chiropractic spinal and/or extraspinal manipulative treatment. Previously, there was no benefit for this procedure. The underbanked represented 14% of U.S. households, or 18. See Section 5(c) for those benefits. Read More. We now provide only medical benefits for EKGs. Tim graduated from the Queensland University of Technology as a Podiatrist in 2006. He contributes to sports such as Surf Life Saving and Rugby as a volunteer. Note: When we pay secondary to primary coverage you have from a prepaid plan (HMO), we base our benefits on your out-of-pocket liability under the prepaid plan (generally, the prepaid plans copayments), subject to our deductible and coinsurance or copayment amounts. A claim for continuing care or an ongoing course of treatment that is subject to prior approval. Simon Burley has developed expertise in shoulder conditions over many years of postgraduate training. This benefit limitation does not apply if you have primary Medicare Part B coverage. See page 95 for our coverage of these vaccines when provided by pharmacies in the vaccine network. While medication provides temporary relief, you often have to deal with side effects, only to find that the pain keeps coming back. She has a passion for Womens Health and movement analysis, looking at how to youre moving daily that has an impact on your musculoskeletal aches and pains. 19. Read More. His treatment is always provided according to the most recent research and aims to provide each patient with the best possible care that he can. Read More. Jayden graduated from Southern Cross University on the Gold Coast, where he worked in private practice before transitioning to the Sunshine Coast. She is a previous two-time Oceania Champion in the Open Womens Long Jump. Surprise bills can happen when you receive emergency care when you have little or no say in the facility or provider from whom you receive care. 32 Genuinely Helpful Gifts for Someone Going Through Chemo. He enjoys helping people from all walks of life to meet their nutritional goals by tailoring advice to their individual circumstances. Combining a love for exercise and a desire to help people, Ben dove straight into the studies of Exercise Physiology and through his experience has further cultivated a passion for Musculoskeletal and Neurological rehabilitation. This brochure is the official statement of benefits. Read More. Your Costs for Covered Services Section 5. We cover up to a combined total (medical and mental health and substance use disorder) of 30 days per calendar year of inpatient care provided and billed by an RTC for members enrolled and participating in case management through the Local Plan, when the care is medically necessary for treatment of a medical, mental health, and/or substance use disorder: Note: Residential treatment center benefits are not available for facilities licensed as skilled nursing facilities, group home, halfway house or similar type facilities. Needles were inserted into the superior joint space of dental students during maximal clenching, both with and without a flat plane appliance in place. If your physician or hospital tries to collect more than allowed by law, ask the physician or hospital to reduce the charges. After moving to Vancouver in June 2012, he became registered with the College of Massage Therapists of British Columbia. Example: You pay 30% of the Plan allowance for durable medical equipment obtained from a Preferred provider, after meeting your $500 calendar year deductible. Services provided by phone or secure online video/messaging for evaluation and management services. But if youve been diagnosed with Menieres disease, ruling out TMJ/D is important because it is a known cause all the symptoms of Menieres disease. Hearing aids including bone-anchored hearing aids. Drugs ordered online may be delivered to your home and these online orders are a part of the Retail Prescription Drug Program described on page 93. WebCover Page Important Notice Table of Contents Introduction Plain Language Stop Healthcare Fraud! If you are living in such a country, you may obtain your prescription drugs from a local overseas pharmacy and submit a claim to us for reimbursement by faxing it to 001-480-614-7674 or filing it via our website at www.fepblue.org/myblue. Our deadline for responding to your claim is stayed while we await all of the additional information needed to process your claim. Emily is available for Remedial Massage appointments at our Nambour clinic. We will treat any reduction or termination of our pre-approved course of treatment before the end of the approved period of time or number of treatments as an appealable decision. But if youve been diagnosed with Menieres disease, ruling out TMJ/D is important because it is a known cause all the symptoms of Menieres disease. Benefits are limited to care provided by covered facility providers (see pages 17-18). There is a $10 visit copayment for each of the first 10 visits to a professional provider per calendar year. Some members may receive guidance and clinical support for an acute healthcare need while others may benefit from a short term case management enrollment. Brooke is passionate about helping people to regain function so they are able to enjoy active lifestyles. He is also interested in sports injuries. Physicians consider many features to determine how diseases will respond to different types of treatments. Vidal is available for Physiotherapy appointments at our Hervey Bay clinic. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Her treatment involves manual lymphatic drainage, compression therapy, exercise prescription, and education. An authorization by the enrollee or spouse for us to issue payment of benefits directly to the provider. Previously, one EKG per calendar year was covered under the preventive care adult benefit with no member cost-share. Examples include an anterior repositioning appliance (ARA) and a mandibular orthotic repositioning appliance (MORA) (Figure 2). You will not be billed for inpatient services when care is related to treatment of specific hospital-acquired conditions if you use Preferred hospitals. We reimburse costs for transportation (air, rail, bus, and/or taxi) and lodging if you live 50 miles or more from the facility, up to a maximum of $5,000 per transplant for the member and companions. Covered medical supplies and equipment, including oxygen, Delivery, operating, recovery, and other treatment rooms. For a complete description of the program or to find a provider near you, go to www.fepblue.org/vcap. She also has a keen interest in neck and back injuries but enjoys treating all areas of the body. See page 43 for our coverage requirements for preventive BRCA testing. To ease discomfort, you can try breathing in steam in the shower or with a humidifier or rinsing your nasal passages with saline. Having had professional coaching in triathlons (all disciplines) Rod has a good understanding of the sports-related issues and injuries that can occur and can assist to analyze and offer remediation. In 2018, Simon qualified as a Certified Health Coach, which has provided him with greater knowledge regarding the role of lifestyle factors such as diet, exercise, and sleep on physical health, mental health, and pain management. These appliances should not be worn for longer than 24 to 48 hours continually, as they cover the maxillary anterior teeth, and intrusion/supra-eruption of posterior teeth could occur from lack of contact. An example is the individual diagnosed with a muscular TM joint that does not achieve total muscle relaxation with treatment. 16. Chloe graduated from the Registered Massage Therapy Program at CDI College and passed the board e She hopes to deliver an optimal standard of care to her patients to help them achieve their goals and get them back to the things that they enjoy. Must meet the definition of medical food (see definition on page 131), Must be receiving active, regular, and ongoing medical supervision and must be unable to manage the condition by modification of diet alone, Inborn errors of amino acid metabolism up to age 22, Food allergy with atopic dermatitis, gastrointestinal symptoms, IgE mediation, malabsorption disorder, seizure disorder, failure to thrive, or prematurity, when administered orally and is the sole source (100%) of nutrition. See page 132 for our payment for inpatient stays resulting from an emergency delivery at a hospital or other facility not contracted with your Local Plan. Our Nurse Advice Line is available 24/7 at 1-833-925-0398. Splint therapy can utilize CR as the physiologic treatment position. Are Earbuds Putting Your Hearing at Risk? Maddie is an experienced podiatrist who, since graduating in 2015, has worked in private podiatry practices in both Australia and the United Kingdom. Balance billing happens when you receive a bill from the non-participating provider, facility, or air ambulance service for the difference between the Non-participating providers charge and the amount payable by your health plan. See page 57 for the benefits available for the surgical removal of breast, ovaries, or prostate cancer when screening reveals a BRCA mutation: preventive care benefits are not available. Allogeneic blood or marrow stem cell transplants for: Glial tumors (e.g., anaplastic astrocytoma, choroid plexus tumors, ependymoma, glioblastoma multiforme). Please refer to Section 4, Your Costs for Covered Services, for related benefits information. 1993;11:184-191. Paulines primary experience is in remedial and relaxation massages, but she also has experience with pregnancy, deep tissue, and hot stones. Di believes it doesnt matter how old you are or your fitness level; everyone will benefit from a remedial massage. Overseas care: Services provided outside the United States, Puerto Rico, and the U.S. Virgin Islands are considered overseas care. Landon graduated from the University of Queensland with a Master of Physiotherapy Studies having previously completed a Bachelor of Exercise and Movement Science. See page 19. Naomi is available for Dietitian appointments at our Broadbeach and Robina locations. Gema is also a recognised trainer with the Australian Football League Womens (AFLW) Brisbane Lions team. Each trial has a protocol which explains the purpose of the trial, how the trial will be performed, who may participate in the trial, and the beginning and end points of the trial. However, she does love her coffee and Sunday brunches. Kim is available for Podiatry appointments at our Nambour and Coolum clinic. Mariella is available for Exercise Physiology appointments at our Coolum clinic. We will send each new enrollee an FEP Blue Focus identification card, which covers pharmacy and medical benefits. When this swelling occurs, it blocks off the opening of the eustachian tubes so you can start to develop pressure behind the ear drum and in some cases, fluid buildup as well.. Please note, your healthcare provider must know when and where they can treat you. OPM will send you a final decision within 60 days. With parafunctional movement laterally, a mandibular splint that does not touch all of the anterior teeth is acceptable (it must touch the cuspids for guidance, but to extend it to touch the incisor teeth would be uncomfortable and unsightly). A U.S. FDA-approved biosimilar drug that may be automatically substituted for the original brand-name biologic drug. Is not, other than incidentally, an extended care facility; a nursing home; a place for rest; an institution for exceptional children, the aged, drug addicts, or alcoholics; or a custodial or domiciliary institution having as its primary purpose the furnishing of food, shelter, training, or non-medical personal services. Ben believes in a person-centred approach to rehabilitation, ensuring all individuals are listened to and involved in curating their treatment plan. Simon has 1 published article on shoulder pain (Please click the title below): Simon has also been involved with Shoulder research trials (Please click the titlesbelow): Simon has been selected from thousands of physiotherapists in Australia to be included in theShoulder and Elbow Physiotherapist group(SEPA). Read More. Kurt is available for appointments at ourNorth Lakes clinic. If you have an emergency admission due to a condition that you reasonably believe puts your life in danger or could cause serious damage to bodily function, you, your representative, the physician, or the hospital must phone us within two business days following the day of the emergency admission, even if you have been discharged from the hospital. After graduating with a Bachelor of Physiotherapy with Distinction, Sam made the move up to the Sunshine Coast where he now calls home. With our "hands on" approach we focus our attention to optimizing your recovery and finding the root cause of the injury to get back to full functionality and strength in the quickest and most efficient manner. If your physician: Does not participate with Medicare and is in our Preferred networkThen you are responsible for: your deductibles, coinsurance, copayments, and any balance up to 115% of the Medicare-approved amount. Zoes interest in a healthy lifestyle and general well-being will provide clients with a holistic treatment approach. Costs associated with repatriation from an international location back to the United States are not covered. Ed has been fortunate to have worked in various clinical settings, which have given him a wholesome understanding of physiotherapy to a variety of patient groups and settings. For a complete list of immunizations go to the Centers for Disease Control (CDC) website at, USPSTF A and B recommended screenings such as cancer, osteoporosis, depression, and high blood pressure. Prescribed by your physician (i.e., the physician who is treating your illness or injury); A drug, device, or biological product that cannot be lawfully marketed without approval of the U.S. Food and Drug Administration (U.S. FDA); and approval for marketing has not been given at the time it is furnished; or, Reliable evidence shows that the healthcare service (e.g., procedure, treatment, supply, device, equipment, drug, biological product) is the subject of ongoing phase I, II, or III clinical trials or under study to determine its maximum tolerated dose, its toxicity, its safety, its efficacy, or its efficacy as compared with the standard means of treatment or diagnosis; or, Reliable evidence shows that the consensus of opinion among experts regarding the healthcare service (e.g., procedure, treatment, supply, device, equipment, drug, biological product) is that further studies or clinical trials are necessary to determine its maximum tolerated dose, its toxicity, its safety, its efficacy, or its efficacy as compared with the standard means of treatment or diagnosis; or. We also have a network of professional providers who have agreed to accept a negotiated amount as payment in full for their services. Katherine is experienced in all areas of podiatry with a particular interest in musculoskeletal conditions, sports injuries and rehabilitation, and ingrown toenail surgery. ), For inpatient stays at Non-member facilities resulting from medical emergencies or accidental injuries, or for emergency deliveries, our allowance is now the lesser of the billed amount or the qualifying payment amount (QPA) determined in accordance with federal laws and regulations. Providers demonstrate quality care, treatment expertise and better overall patient results. Outside of work, Georgia enjoys participating in gym classes, going for bush works, volunteering for Bush care and spending time with friends and family. J Oral Maxillofac Surg. Paul completed his Dip in 2021 at Q Academy Sunshine Coast. *The Core benefits do not include Tier 2 brand-name drugs or any specialty drugs (including generic specialty drugs), see WRAP benefits listed on page 37. Pauline has worked as a Massage Therapist in Noosa and Brisbane; Paulinehas recently moved to Hervey Bay. Laura has postgraduate training in lower back and pelvic injuries and clinical Pilates and spinal rehabilitation. After completing a degree in Exercise Physiology followed by Physiotherapy in Sydney, Mandy decided to explore more of Australia, particularly Queensland and its warmer waters. Pharmacotherapy (medication management) (See Section 5(c) for our coverage of drugs administered in connection with these treatment therapies. A study of patients with nocturnal bruxism revealed that 13% exhibited isometric clenching, 71% exhibited bilateral clenching, 13% exhibited unilateral excursion, and 3% exhibited protrusive movement6 (Figure 3). However, special rules apply when Medicare or another payer is primary, see pages 23-24. Urgent care centers, not licensed as or permitted to provide emergency services and supplies, including professional providers services, diagnostic studies, radiology services, laboratory tests and pathology services, when billed by the provider. Read More. Grace is available for Exercise Physiology appointments at our Springfield clinic. The following accidents are considered ineligible: the breaking or injury of natural teeth caused by dental care, when eating, or by ineligible motor vehicle accidents (see Section VIII.C.2). We will write to you with our decision. Jaime has completed post-graduate study and many advanced courses in pelvic health; taught university students both on an undergraduate and postgraduate level; presented at international conferences; headed the Allied Health teams for Persistent Pelvic Pain clinics in the areas of Endometriosis and Pelvic Mesh injuries, and worked in both the public and private sectors of health and Physiotherapy. Outpatient treatment services performed and billed by a facility, are limited to: *Prior approval is required, see pages 19-22 for prior approval requirements. Example: When you see your Preferred professional provider for physical therapy, you pay a copayment of $25 for the visit, and we then pay the remainder of the amount we allow for the visit. Sherry decided to become a Remedial Massage Therapist as she is passionate and wanted to help patients increase their body movement. Aravinth graduated from the University of Peradeniya, Sri Lanka, in 2011 with a Bachelors degree in physiotherapy. Being a keen runner, gym-goer, and cook, Montana loves promoting a healthy (but balanced) lifestyle. Craniomandibular disorders in patients with different types of headache. This Section primarily deals with post-service claims (claims for services, drugs, or supplies you have already received). We pay preventive care benefits on the first claim we process for each of the above tests you receive in the calendar year. You can find more information about how our Plan coordinates benefits with Medicare in our Medicare and You Guide for Federal Employees available online at www.fepblue.org. Flying to a new destination is exciting and wonderful, but it can lead to ear congestion, or airplane ear. (Yes, thats a thing.) Anna has experience providing psychological support for conditions such as depression, anxiety, eating disorders, grief and loss, conflict, anger, and stress. Michael has developed a keen interest in musculoskeletal physiotherapy, particularly in injury prevention and sports physio. If you live in one of these counties, we will provide language assistance in the applicable non-English language. On the orthopaedic ward, Montana fostered her understanding of surgical procedures and protocols and developed key relationships with some of the worlds leading surgeons. She works alongside patients wherever they are at on their health journey and applies evidence-based practice to ensure the best outcomes possible. The Routine Annual Physical Incentive Program rewards members for receiving a routine annual physical exam. Services, drugs, or supplies billed by Preferred and Member facilities for inpatient care related to specific medical errors and hospital-acquired conditions known as Never Events (see definition on page 131). For more detailed information on What is Medicare? and Should I enroll in Medicare? please contact Medicare at 1-800-Medicare 800-633-4227, TTY: 877-486-2048, or at www.medicare.gov. She also completed courses in Dry Needling and Western Acupuncture and conducted regular Mat Pilates sessions. Home remedies: Rest and care for your jaw by eating soft foods and using warm or cold compresses on your jaw area. Bills for home nursing care must show that the nurse is a registered or licensed practical nurse. If Medicare offers an approved program for an anticipated organ transplant, but your facility is not approved by Medicare for the procedure, please contact your Local Plan at the customer service phone number appearing on the back of your ID card. Vision Care Affinity Program Service Benefit Plan members can receive routine eye exams, frames, lenses, and conventional contact lenses at substantial savings when using Davis Vision network providers. If the patient reports bruxism and headaches but no TMD, the use at night of a full-coverage splint, in which acrylic covers an entire arch of teeth, is often adequate to protect the teeth. Certified Gunn IMS (Intramuscular Stimulation), American Balance Institute Certified in Vestibula You must tell us if you or a covered family member has coverage under any other group health plan or has automobile insurance that pays healthcare expenses without regard to fault. Uma has been practicing physiotherapy for over 20 years. Outside of the various football codes, Paul previously coordinated physiotherapy services for the Tri-Alliance triathlon squad and has treated many national and international level athletes in track and field and cycling. An accidental injuryis an injury caused by an external force or element such as a blow or fall and which requires immediate medical attention, including animal bites, and poisonings. Robert is available for Physiotherapy appointments at our Robina clinic. Note: For information regarding the Plan allowance, see. You must use Preferred providers for your care to be eligible for benefits, except in certain circumstances, such as medical emergency or accidental injury services. You must also pay any charges for noncovered services. (See pages 39 and 86.). Please read Important things you should keep in mind at the beginning of the subsections. With interest in lifestyle medicine both personally & professionally, she is passionate about finding their best quality of life at all different stages. Please allow ample time to complete all activities by this date. Discrimination is Against the Law Preventing Medical Mistakes FEHB Facts Section 1. Benefits are not available for BRCA testing performed at Member or Non-member facilities. Jordan grew up playing a variety of sports, with cricket and basketball being the most prominent. ), Under our maternity benefit, we now offer a breast pump and milk storage bags for members who are pregnant and/or nursing when ordered through our fulfillment vendor. Alongside treating clients, he has a keen interest in helping mentor other Physiotherapists to provide exceptional care to their patients. Outpatient drugs, medical devices, and durable medical equipment billed for by a facility, such as: Precertification prior to admission is required. He is a member of Sports Medicine Australia and a member of the Australian College of Physiotherapists. Rachael has a special interest in, overweight and obesity, chronic disease management, and Womens health. These cookies ensure basic functionalities and security features of the website, anonymously. 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