List Of Operations

SCHEDULE OF OPERATIONS
 
ABDOMEN
  • Appendectomy, freeing of adhesions or exploration of, or cutting into, the abdominal cavity
  • Removal of, or other operation on gall bladder 
  • Gastro-enterostomy
  • Resection of stomach, bowel or rectum 

ABSCESSES (See Tumors)

 

AMPUTATIONS
  • Thigh, leg
  • Upper arm, forearm, entire hand or foot 
  • Fingers or toes,each
BREAST
  • Removal of benign tumor or cyst 
  • Simple amputation
  • Radical amputation
CHEST
  • Complete thoracoplasty, transthoracic approach to stomach, diaphragm or esophagus; sympathectomy or laryngectomy
  • Removal of lung or portion of lung cauterization or conization, polypectomy, 
  • Brochoscopy, esophagoscopy
  • Induction of artificial pneumothorax, initial refills each (not more than 12) 
 

CYSTS (See Tumors)

 

DISLOCATION, REDUCTION OF

  • Hip, vertebra or vertebrae, ankle joint, elbow or knee joint (patella excepted)
  • Shoulder 
  • Lower jaw, collar bone, wrist or patella 

For a dislocation requiring an open operation, the maximum will be twice the amount shown above

 

EXCISION OR FIXATION BY CUTTING
  • Hip joint 
  • Shoulder, knee joint, semilunar cartilage, elbow, wrist or ankle joint
  • Removal of diseased portion of bone, including curettage (alveolar process excepted
EAR, NOSE OR THROAT
  • Mastoidectomy, one or both sides: Simple; Radical
  • Tonsillectomy, adenoidectomy, or both
  • Sinus operation by cutting( puncture of antrum excepted)
  • Submucuos resection of nasal septum 
  • Tracheotomy 
  • Any other cutting operation
EYE
  • Operation for detached retina 
  • Cataract, removal of 
  • Any other cutting operation into the eyeball (through the cornea or sclera) or cutting operation on eye muscles
  • Removal of eyeball 
FRACTURE, TREATMENT OF
  • Thigh, vertebra or vertebrae, pelvis, (coccyx excepted)
  • Leg, kneecap, upper arm, ankle (Potts) 
  • Lower jaw (alveolar process excepted), collar bone, shoulder blade, forearm, wrist (Colles), skull
  • Hand, foot
  • Fingers or toes, each 
  • Nose
  • Rib or ribs, three or more, or fewer than three 
The amounts shown above are for simple fractures
For a compound fracture, the maximum will be one and one-half times the amount for the corresponding simple fracture
For a fracture requiring an open operation with grafting, bone splinting, or metallic fixation at point of fracture, the maximum will be twice the amount for the corresponding simple fracture
For a compound fracture, the maximum will be one and one-half times the amount for the correspon - ding simple fracture.

For a fracture requiring an open operation with grafting, bone splinting, or metallic fixation at point of fracture, the maximum will be twice the amount for the corresponding simple fracture.

 

GENITO-URINARY TRACT
  • Removal of, or cutting into, kidney
  • Fixation of kidney 
  • Removal of tumors or stones in ureter or bladder: 
  • by cutting operation 
  • by endoscopic means 
  • Cystoscopy
  • Prostatectomy
  • Simple punch for median bar
  • Partial resection via cytoscope 
  • Complete removal, any approach 
  • Varicocele, hydrocele, orchidectomy or epididymectomy, single or bilateral
  • Hysterectomy or panhysterectomy 
  • Other cutting operations on uterus and its appendages with abdominal approach
  • Cervix amputations
  • Vaginal plastic, operation for cystocele or rectocele
GOITRE
  • Removal of thyroid, subtotal 
  • Removal or adenoma or benign tumor of thyroid
HERNIA
  • Single hernia 
  • More than one hernia
JOINT
  • Incision into, tapping excepted 
LIGAMENTS AND TENDONS
  • Cutting or transplant, single or multiple
  • Suturing of tendon, single or multiple
  • Fenestration, one or both sides
PARACENTECIS
  • Tapping
PILONIDAL CYST OR SINUS
  • Removal of
RECTUM
  • Hemorrhoidectomy, external, internal or internal and external 
  • Cutting operation for fissure
  • Cutting operation for thrombosed hemorrhoids
  • Cutting operation for fistula-in-ano, single, multiple
SKULL
  • Cutting into cranial cavity (trephine excepted) 
  • Trephine
SPINE OR SPINAL CORD
  • Operation for spinal cord tumor
  • Operation with removal of portion of vertebra or  vertebrae (except coccyx, transverse or spinuous process) 
  • Removal of part or all of coccyx, or of transverse or spinuous process
TUMORS
  • Benign or superficial tumors and cysts or abscesses
  • Malignant tumors of face, lip or skin 
VARICOSE VEINS
  • Injection treatment, complete procedure; One or both legs 
  • Cutting operation, complete procedure; One or both legs 
 
 
If the operation performed is not shown in the Schedule of Operations and is not expressly excluded by any of the terms of this Policy, the Company shall determine the payment for such operation and will furnish the facts on which the cancellation is based