Download OB-GYN, Family Planning and Sensitive Services

OB-GYN, Family Planning and Sensitive Services Under the
Alliance Plan
Under Alliance plans, routine OB/GYN services, Family Planning and Sensitive Services are
self-referral services and do not require a PCP RAF.
Members are allowed freedom of choice of OB-GYN, Family Planning and Sensitive Services
and may receive such services from any properly licensed provider, including those out-of-plan,
without prior authorization.
Family Planning and Sensitive Services
Family Planning Services include birth control and pregnancy testing and counseling.
Sensitive Services include pregnancy testing and counseling, birth control, AIDS/HIV testing, sexually
transmitted disease testing and treatment, and termination of pregnancy.
Family Planning services and Sensitive Services are listed below:
 Health education and counseling necessary to make informed choices and understand
contraceptive methods
 Limited history and physical examination
 Laboratory tests if medically indicated as part of decision making process for choice
of contraceptive methods*
 Diagnosis and treatment of STDs if medically indicated**
 Screening, testing and counseling of at risk individuals for human immunodeficiency
virus (HIV) and other STDs and referral for treatment**
 Follow-up care for complications associated with contraceptive methods issued by
the family planning provider
 Provision of contraceptive pills/devices/supplies
 Tubal ligation
 Vasectomies
 Genital herpes
 Viral warts, both specified and unspecified
 Condyloma acuminatum
OB-GYN, Family Planning and Sensitive Services
Under the Alliance Plan
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 Syphilis and other venereal diseases
 Candidiasis / Molinia
 Trichomonas
 Phthirus pubis (pubic louse)
 Scabies
 PID – unspecified organism
 Inflammatory disease of uterus, except cervix
 Dysplasia
 Abortion (legal, unspecified, failed)
 Termination of pregnancy
 Contraception and contraceptive management
 High-risk sexual behavior
 Observation following alleged rape or seduction
 Pregnancy exam or test, pregnancy unconfirmed
 Rape examination
*
Pap smear is included as a family planning service if performed according to the
United States Preventive Services Task Force Guidelines, which specifies cervical
cancer screening every 1-3 years based on the presence of risk factors (early onset of
sexual intercourse, multiple sexual partners); however, PAP smear annual frequency
may be reduced if 3 or more annual smears are normal.
** Based on HCFA’s Medicaid policies, STD diagnosis and treatment and HIV testing
and counseling, provided during a family planning encounter, are considered part of
family planning services.
Please Note: Infertility services are NOT covered under Family Planning and are excluded along
all lines of business.