Question: What costs are covered under my Federal Black Lung Program medical benefits?
Answer: The cost of medical treatment services and associated travel directly related to the treatment of your lung condition are covered as authorized under the Federal Black Lung Benefits Act. These costs are payable in full, in keeping with established customary rates for covered medical services. There is no deductible.
The following is a list of services that MAY be covered when they are performed for the treatment of your lung condition:
- Doctor's office calls, hospital visits, and consultations;
- Inpatient and outpatient hospital charges, including emergency room visits for ACUTE lung conditions, diagnostic laboratory testing and chest
- Federal Black Lung Program APPROVED prescription drugs, both brand name and generic;
- Ambulance services limited to transportation to the hospital for emergency ACUTE lung care; and,
- Travel to the doctor, hospital, clinic, or other medical facility for round trips of 150 miles or less.
The following items require special approval:
- The purchase or rental of home medical equipment such as oxygen systems
(requires Certificate of Medical Necessity completed by prescribing physician);
- Pulmonary rehabilitation (breathing retraining) programs (requires Certificate of Medical Necessity completed by prescribing physician);
- Home health care visits for skilled nursing (requires Certificate of Medical Necessity completed by prescribing physician); and,
- Overnight travel, related meals and lodging, and/or mileage that exceeds 150 miles round trip (requires special approval from your Division of Coal Mine Workers' Compensation (DCMWC) District Office).