Disease Management Services

Contact (810) 232-7740

GHP care managers help members receive the care, education and support they need to manage their diseases and lead healthy lifestyles.  Care managers may be able to help link you to other resources in teh community for needed services that are not a covered benefit.

N/A

Dental

Not covered - including services performed by an oral surgeon

N/A

Diabetic Education

Covered if ordered by an MD, DO, NP. Coverage limited to diagnosi code 250.00-250.93 and procedure codes G0108 and G0109.

N/A

Eyeglasses

Not covered - Call GHP at (810) 232-7740 for discounted eyeglasses.

N/A

Hearing Aids

Not covered

N/A

Home Help (personal care)

Not covered

N/A

Inpatient Hospital

Not covered

N/A

Medical Supplies/Durable Medical Equipment (DME)

Limited coverage:
(Great Lakes Medical is the exclusive provider for Diabetic Supplies)

Medical supplies such as gauze, bandages and ostomy supplies are covered except for the following not covered catagories:

• Gradient surgical garments, formulas and feeding supplies, and supplies related to any  DME item not covered.
• DME items are Not covered except for glucose monitors.

No copays for diabetic supplies

$5 copay for other supplies

Nursing Facility

Not covered

N/A

Outpatient Hospital (Not emergency department)

Covered:

1. Services performed by a radiologist. Both facility and professional services are covered.
2. Care Core reviews services as appropriate . 
3. Professional services.
4. Wound therapy services.
5. Physical, Occupational & Speech Therapy evaluation only. (See "Physical Therapy secion in this table).
6. Diabetic Education (See "Diabetic Education" section in this table).
7. Antibiotic Infusion Therapy
8. If a GHP Plan B member receives a bill for outpatient facility services, please contact GHP at (810) 232-7740

Not covered:

1. Nuclear radiology (includes tests like PET and radioisotope related procedures). 
2. MRI/MRA
3. Facility services for surgeries (other than services performed by a radiologist) 
4. Pain management services performed by a pain management specialist.
5. Emergency room or after hours.
6. Services related to ER or after hours.
7. Chemotherapy
8. IV Infusion Therapy (other than antibiotic infusion therapy)
9. Dialysis
10. Sleep studies
11. 23-hour holds, dental related services and cardiac rehab

$50 Copay:
Professional
FOR ALL PROFESSIONAL SERVICES IN OUTPATIENT HOSPITAL

$5 Copay:
Facility/hospital
FOR COVERED SERVICES.

Not Covered:
Services performed in a Free Standing Surgery Center or Ambulatory Surgery Center

Physician

Nurse Practitioner

Oral Surgeon

Medical Clinic

Annual physical exams (including a pelvic and breast exam, and pap test). Women who qualify for screening/services under Breast and Cervical Cancer Programs administered by the Local Health Department may be referred to that program for services as appropriate.

• Diagnostic and treatment services.  May refer to local health department for TB, STD or HIV-related services, as available and appropriate.
• General opthalmologic services (procedure codes 92002-92014). 
• Limited immunizations through physician office or McLaren Visitng Nurses: Hepatitis A & B, Influenza, MMR, Meningococcal Meningitis, Pneumococcal Polysaccharide, Polio, Tetanum, Tdap, Varicella. (Travel immunizations are not covered). 
• Injections administered in a physician’s office per current Medicaid policy. Some injections may require prior authorization.
• Oral surgery for medically necessary services with a valid referral from a member's primary care physician

$3 copayment for Primary Care Physician

$10 copayment for Specialist Physician

$10 copayment for office-based surgery

Prosthetics/Orthotics

Not covered

N/A

Substance Abuse

Not Covered by GHP: Services available through local Mental Health/Substance Abuse programs; must qualify through these agencies.

N/A

Transportation (including non emergency ambulance)

Not covered

N/A