Medical Supplies and Durable Medical Equipment

BRAND NAME: Wide-Seal Diaphragm 90

GENERIC NAME: 
diaphragm wide seal No Generic Available
  Status Notes or Restrictions
Anthem Blue Cross (HMO, PPO, EPO) approved.gif (510 bytes)  
Cigna + Oscar notlisted.gif (324 bytes)  
Health Net preferred.gif (540 bytes) NOTES.gif (377 bytes)
Kaiser Foundation Health Plan Northern California preferred.gif (540 bytes) NOTES.gif (377 bytes)
Kaiser Foundation Health Plan Southern California preferred.gif (540 bytes) NOTES.gif (377 bytes)
Oscar preferred.gif (540 bytes) NOTES_restrict.gif (377 bytes)
Sharp Health Plan notreimb.gif (645 bytes)  
Sutter Health Plus notlisted.gif (324 bytes)  
UnitedHealthcare preferred.gif (540 bytes) NOTES.gif (377 bytes)
Western Health Advantage approved.gif (510 bytes) NOTES_restrict.gif (377 bytes)


preferred.gif (540 bytes)  Preferred

approved.gif (510 bytes)   Approved

priorauth.gif (816 bytes)  Prior Auth.

nonform.gif (625 bytes)    Non-Formulary notreimb.gif (645 bytes)   Not Reimbursed notlisted.gif (324 bytes)   Not Listed
nonform.gif (625 bytes)    Benefits/Policies generic.gif (400 bytes) Generic Available, Brand Listed for reference only. Brand may not be covered.

NOTES.gif (377 bytes)NOTES_restrict.gif (372 bytes)

Notes or
Restrictions

For additional information, please click on "Your Questions" in the left navigation bar.

Back to top