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Covered
Harvard Pilgrim Health Care offers a variety of coverages when it comes to healthcare treatments and situations. They typically cover services like preventive care, emergency services, hospitalization, and maternity and newborn care. Members may also receive coverage for mental health, behavioral health, and substance use disorder services. Prescription drugs are usually covered, as are rehabilitative services and devices. Additionally, this insurance often includes pediatric services, including oral and vision care. For those undergoing allergy immunotherapy, the coverage would generally include the allergy testing, the serum for the allergen, and the administration of the immunotherapy by a healthcare professional, so long as these are deemed medically necessary and are performed in accordance with the plan's guidelines. Keep in mind, coverage can vary by plan and individual circumstances, and it's essential for members to review their specific policy and consult with Harvard Pilgrim Health Care for the exact coverages.
Uncovered
Pilgrim Health Care coverage parameters, I can outline some treatments or situations typically not covered. These often include cosmetic surgery, hearing aids for adults, weight loss surgery (unless medically necessary), non-prescription medications, and experimental treatments. Additionally, long-term custodial care, fertility treatments not medically necessary, and elective abortions may also be excluded from coverage. It's crucial for policyholders to review their individual plan documents for specific exclusions, as these can vary based on the plan type and state regulations.
