Arizona Long Term Care System
ALTCS Non Covered Medical Services
Non-Covered Medical Services
Not all services are covered. This includes, but is not limited to:
Not all services are covered. This includes, but is not limited to:
- Care that is not medically necessary;
- Services that need approval but not approved;
- Care provided by a person who is not properly licensed or certified;
- Cosmetic services or items; and,
- Drugs and supplies without a prescription.
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Non-Covered Services
The following services are not covered for adults. If you have other insurance, you may be covered.
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- Medical Equipment: Medical equipment may be purchased or rented only when there are no reasonable alternative resources from which the medically necessary medical equipment can be obtained at no cost. Additionally, the total expense of rental cannot exceed the purchase price of the item. Rental fees must terminate no later than the end of the month in which the member no longer needs the medical equipment, or when the member is no longer eligible or enrolled with a Contractor, except during transitions as specified by the AHCCCS Chief Medical Officer or designee.
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Maintenance and repair of parts will still be paid for.
Reasonable repairs or adjustments of purchased equipment are covered for all members over and under the age of 21 to make the equipment serviceable and/or when the repair cost is less than renting or purchasing another unit. The component will be replaced, if at the time authorization is sought, documentation is provided to establish that the component is not operating effectively. |
- Emergency Dental Service: Emergency services are when you have a need for care immediately, like a bad infection in your mouth, or pain in your teeth or jaw. Service excluded from payment: AHCCCS will not cover dental services (including emergency dental services) unless the care needed is a medical or surgical service related to dental (oral) care. Covered dental services for members 21 years of age and older must be related to the treatment of a medical condition such as acute pain, infection, or fracture of the jaw. Covered dental services include examining the mouth, x-rays, care of fractures of the jaw or mouth, giving anesthesia, and pain medication and/or antibiotics. Certain pre-transplant services and prophylactic extraction of teeth in preparation for radiation treatment of cancer of the jaw, neck, or head is also covered.
- Services by Podiatrist: Any service that is done by a doctor who treats feet and ankle problems. Service excluded from payment: services provided by a podiatrist or podiatric surgeon for persons over 21 years of age. Contact your acute health plan for other contracted providers who can perform medically necessary foot and ankle procedures, including reconstructive surgeries.
- Prescription Drugs Not Covered (Medicare Recipients) AHCCCS does not pay for any drugs paid by Medicare. They also do not pay for any out of pocket costs, even if you do not pick a Part D Plan.
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AHCCCS does not pay for barbiturates to treat epilepsy, cancer, or mental health problems or any benzodiazepines for members with Medicare. AHCCCS pays for barbiturates for Medicare members that are not used to treat epilepsy, cancer, or chronic mental health conditions. This is because federal law required Medicare to begin paying for these drugs. Some of the common names for benzodiazepines and barbiturates are:
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Alprazolam................................................ Xanax
Diazepam.................................................. Valium Lorazepam................................................. Ativan Clorazepate Dipotassium..................... Tranxene Chlordiazepoxide Hydrochloride........... Librium Clonazepam.......................................... Klonopin |
Oxazepam................................................. Serax
Temazepam.......................................... Restoril Flurazepam......................................... Dalmane Phenobarbital............................. Phenobarbital Mebaral..................................... Mephobarbital |
