[Pamphlet advertising Blue Cross Blue Shield Surgical Care] Page: 2 of 2
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Blue Shield is the official insignia of Associated Medi-
cal Care Plans, comprised of this and 51 other non-
profit medical and surgical plans.3lae shield P lhaiid*l
1. Payments on surgical procedures. (See schedule at
right.)
2. Up to $3.00 per day for doctors' services in medical
hospital cases after the first seven days and for a period
of twenty-eight days each year.
3. Maternity care after first twelve months continuous man-
and-wife or full-family membership.
4. The same protection to all members of the family.
Employee, husband or wife, and dll unmarried children
under nineteen. Unmarried children between the ages of
nineteen and twenty-five may be included as sponsored
dependents.
Benefits are available for services by any doctor of medi-
cine who is in good standing with his local county medical
society.
WVol 9.~c~e
The plan includes all general surgical procedures and
medical care, but does not include benefits where care is
received under state or federal laws, or for pre-existing
conditions, dental or oral surgery or X-ray services. Removal
of tonsils and adenoids is not covered during first 6 months.L2lae Sitide
?4o~upR /e .~ee4
1. Blue Cross groups with participation as follows:
If the Number of Employees Is: The Number Required Is:
5 (Minimum group eligible) 5
6-10 All but one
11-16 All but three, minimum of 9
17-20 All but four
21 or more 50%, minimum of 16
2. Monthly payments to be handled through payroll.The American Medical Association has officially
approved Group Medical and Surgical Service of
Texas as meeting all its standards.I
Individual . . . . . . . . . $ .75
Member and one or more dependents . 2.00
Each sponsored dependent . . . . .75
Repeated use of services, increasing age, change or resignation of
employment do not cancel membership or increase its cost. The plan is
designed to render a service when most needed.S /ic 2ee (inc/iJing OLetrica/)
The following schedule is a partial list of surgical procedures. Payment for all other surgical procedures will be pro-
portionate. The schedule designates the payment to be made to apply as credit against the charge of the physician
and does not fix the value of his services. When more than one operative procedure takes place at one time, only
the maximum allowable benefit will be paid for the major surgery.ABDOMEN
Appendectomy .........................$100.00
Gastrectomy .............................. 150.00
Other cutting into abdominal
cavity for diagnosis or treat-
ment of organs therein (unless
otherwise specified below) .... 100.00
AMPUTATION OF
Thigh .........................................$100.00
Leg, entire foot, arm, forearm
or entire hand........................ 75.00
Fingers or toes-one ............... 15.00
(Each subsequent amputation
from some injury)................ 5.00
ANESTHESIA
Not to exceed..............................$ 10.00
BREAST
Simple amputation ....................$ 75.00
Radical removal ........................ 150.00
Removal of cysts or benign
tum ors .................................. 25.00
Abscess, deep-furuncles ex-
cepted .................................... 25 .00
CHEST
complete thorocoplasty, or re-
moval of portion of lung . .$150.00
Other cutting into thoracic cav-
ity for diagnosis or treatment
(tapping excepted)............ 50.00
Initial induction of artificial
pneumothorax ........................ 10.00
Refills............................. 5.00
Maximum ................... 25.00
DISLOCATION, REDUCTION OF
Knee (patella excepted) ............$ 35.00
Hip ............................................ 35.00
Shoulder .................................... 35.00
Elbow ....................................... 25.00
Ankle ......................................... 25.00
Lower Jaw .................................. 15.00Collar Bone ................................ 10.00
w rist .. .................................... 10.00
For dislocation requiring open opera-
tion the maximum benefits shall not ex-
ceed twice the corresponding amount
shown above. .
EAR, NOSE AND THROAT
Mastoidectomy. One side .........$ 75.00
Both sides .................100.00
Tonsillectomy & adenoidectomy 35.00
(Under 12 years)................... 25.00
Sinus operation by cutting, in-
cluding submucous resection
(puncture of antrum excepted) 50.00
Submucous resection of nasal
septum .....................35.00
Bronchoscopy for drainage, bi-
opsy, or removal of foreign
body or obstruction ................ 50.00
Cutting into trachea .................. 25.00
Other cutting operation (Punc-
ture of antrum and tapping
excepted) .............................. 10.00
EYE
Removal of cataract ..................$ 75.00
Needling of cataract .............35.00
Any cutting operation into the
eyeball (through the cornea
or sclera) .............................. 50.00
cutting of extrinsic eye muscle 50.00
Removal of eyeball .................. 75.00
Other cutting operation on eye-
ball or eye muscle.................. 20.00
FRACTURE, TREATMENT OF
Hip, skeletal traction or internal
fixation ..................................$100.00
Upper arm .................................. 75.00
Kneecap ....... . .................. 50.00
Vertebrae (one or more) (coccyx
and vertebral processes ex-
cepted) .................................. 100.00Legs-
Tibia ...................................... 50.00
Fibula ..................................35.00
Fem ur ............. ............... 75.00
.law ............................................ 50.00
Shoulder Blade .......................... 50.00
Forearm ...................................... 50.00
W rist ......................................... 25.00
Ankle (both bones) ...................... 75.00
Single bones ......................... 35.00
Finger (Metacarpals Phalanges) 25.00
Toes ........................................... 10.00
Nose, rib or ribs........................ 25.00
NOTE-The amounts shown above are
for simple fractures-single or multiple.
For compound fractures the maximum
amount of reimbursement will be one
and one-half times the corresponding
amount shown above. For fracture re-
quiring open operations the maximum
amount of reimbursement will be twice
the corresponding amount shown above,
but in no event to exceed an aggre-
gate of $150.00.
GENITO-URINARY TRACT
Removal of kidney ....................$125.00
Cutting into or fixation of kid-
ney (other than removal of
tumors or stones) .................. 100.00
Removal of tumors or stones in
kidney, ureter or bladder:
By open operation............100.00
By crushing, cauterization or
endoscopic means .................. 35.00
Removal of part of prostate by
open operation (complete pro-
cedure) .................................. 100.00
Removal of part of prostate by
endoscopic means .................. 50.00
Circumcision:
New born .............................. 5.00Child up to 12 years of age 10.00
Adult....................... 15.00
Varicocele, cutting operation in
hydrocele, excision, or inci-
sion and treatment of sac
(tapping excepted) ................ 25.00
Stricture of urethra-open op-
eration ................................. 50.00
Intro-urethral cutting operation 25.00
GOITRE
Thyroidectomy (complete pro-
cedures, including ligation of
thyroid arteries, to be treated
as one operation) ................ 150.00
HERNIA, CUTTING OPERATION
FOR RADICAL CURE
Single hernia ............................$ 75.00
More than one hernia ................100.00
JOINTS
Opening or cutting into for re-
pair of internal derange-
ment of shoulder, hip or
sacroiliac joint ......................$ 75.00
Knee joint .................................. 75.00
Elbow, wrist or ankle joint ........ 50.00
LIGAMENTS OR TENDONS
Cutting operation .....................$ 25.00
Suturing of tendons: Single........ 25.00
M ultiple ................................... 50.00
OBSTETRICS AND GYNECOLOGY
Normal delivery with pre-and
post-natal care .....................$ 50.00
Caesarian Section ...................... 100.00
Miscarriage-abortion ................ 25.00
Extra-uterine pregnancy ............ 100.00
Hysterectomy ............................ 100.00
Dilation and curettage (non-
puerpol) ................................ 25.00
Trachelorraphy and Perineor-
raphy ................................... 50.00
(Continued on Back)' ;
.
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Blue Cross Blue Shield. [Pamphlet advertising Blue Cross Blue Shield Surgical Care], pamphlet, Date Unknown; (https://texashistory.unt.edu/ark:/67531/metapth1341686/m1/2/: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting Rosenberg Library.