Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Manual Wheelchairs

Policy #:05.00.12g

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract.

MEDICAL NECESSITY CRITERIA FOR ALL MANUAL WHEELCHAIRS

A manual wheelchair is considered medically necessary and, therefore, covered when ALL of criteria 1-5 are met AND either criterion 6 OR 7 is met:

1.The individual has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADLs), such as toileting, feeding, dressing, grooming, and bathing, in customary locations in the home.
  • A mobility limitation is one that:
    • Prevents the individual from accomplishing an MRADL entirely, or
    • Places the individual at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform an MRADL, or
    • Prevents the individual from completing an MRADL within a reasonable time frame.
2.The individual’s mobility limitation cannot be sufficiently resolved by the use of an appropriately fitted cane or walker.

3.

The individual’s home provides adequate access between rooms, ample maneuvering space, and surfaces that enable the operation of the manual wheelchair.

4.

The manual wheelchair will significantly improve the individual’s ability to participate in MRADLs, and the individual will use it on a regular basis in the home.

5.

The individual has not expressed unwillingness to use the manual wheelchair in the home.

AND EITHER

6.

The individual has sufficient upper-extremity function and other physical and mental capabilities needed to safely self-propel the manual wheelchair in the home during a typical day.
  • Limitations of strength, endurance, range of motion, coordination, presence of pain, or deformity or absence of one or both upper extremities are relevant to the assessment of upper-extremity function.
OR

7.

The individual has a caregiver who is available, willing, and able to provide assistance with the manual wheelchair.

A transport chair (E1037, E1038, E1039) is considered medically necessary and, therefore, covered when both of the following criteria are met:
  • When used as an alternative to a standard manual wheelchair base (K0001).
  • When the above manual wheelchair base criteria are met (1 through 5, and 7).

ADDITIONAL MEDICAL NECESSITY CRITERIA FOR SPECIALTY MANUAL WHEELCHAIRS

In order for any of the specialty manual wheelchairs listed below to be covered, all of the medical necessity criteria listed above must be met, in addition to the specific criteria listed below for the appropriate specialty wheelchair.

A standard hemi-wheelchair (K0002) with a lower seat height (17 inches to 18 inches) is considered medically necessary and, therefore, covered when an individual meets either of the following criteria:
  • The individual is of short stature.
  • The individual can only place his/her feet on the ground for adequate propulsion when the wheelchair seat height is lowered.

A lightweight wheelchair (K0003) is considered medically necessary and, therefore, covered when an individual meets both of the following criteria:
  • The individual cannot self-propel in the home with a standard manual wheelchair.
  • The individual can and will self-propel in a lightweight wheelchair.

A high-strength lightweight wheelchair is (K0004) considered medically necessary and, therefore, covered if the expected duration of need is three months or greater and the individual meets either of the following criteria:
  • The individual self-propels the wheelchair while engaging in frequent activities in the home that cannot be performed in a standard or lightweight wheelchair.
  • The individual requires a seat width, depth, or height that cannot be accommodated in a standard, lightweight, or hemi-wheelchair, and the individual spends at least two hours per day in the wheelchair.

An ultra-lightweight wheelchair (K0005), is considered medically necessary and, therefore, covered when the individual has a specialty evaluation performed to determine the appropriateness of an ultra-lightweight wheelchair (K0005) by a licensed practitioner (eg, physician, physician assistant, nurse practitioner, clinical nurse specialist, physical therapist, occupational therapist) with training and experience in rehabilitation wheelchair evaluations and meets all of the following criteria:
  • The individual must be a full-time manual wheelchair user.

OR
  • The individual must require individualized fitting and adjustments for one or more features, such as, but not limited to, axle configuration, wheel camber or seat and back angles, which cannot be accommodated by a K0001 through K0004 manual wheelchair.

A heavy-duty wheelchair (K0006) is considered medically necessary and, therefore, covered if the individual weighs more than 250 pounds or has severe spasticity.

An extra heavy-duty wheelchair (K0007) is considered medically necessary and, therefore, covered if the individual weighs more than 300 pounds.

A custom manual wheelchair base (K0008) is only considered medically necessary and, therefore, covered when the individual meets all of the following criteria:
  • The specific configuration required to address the individual’s physical and/or functional deficits cannot be met using one of the standard manual wheelchair bases
  • An appropriate combination of wheelchair seating systems, cushions, options or accessories (prefabricated or custom fabricated), such that the individual construction of a unique individual manual wheelchair base is required.
  • The expected duration of use is three months or greater

A rollabout chair (E1031) is considered medically necessary when the chair has casters of at least 5 inches in diameter and specifically designed to meet the needs of ill, injured, or otherwise impaired individuals.

A manual wheelchair with tilt space (E1161) is considered medically necessary and, therefore, covered, when both of the following criteria are met:
  • The individual must have a specialty evaluation that was performed by a professional provider, such as a PT or OT, or a physician who has specific training and experience in rehabilitation wheelchair evaluations. This specialty evaluation must document the medical necessity for the wheelchair and its special features.
  • The wheelchair is provided by a Rehabilitative Technology Supplier (RTS) that employs a RESNA-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the individual.

NOT MEDICALLY NECESSARY

If the manual wheelchair will only be used outside the home, it is considered not medically necessary and, therefore, not covered. A manual wheelchair that is beneficial primarily in allowing the individual to perform vocational, educational, leisure, or recreational activities is considered not medically necessary and, therefore, not covered.

If the manual wheelchair will be used inside the home but the medical necessity criteria listed in this policy are not met, the wheelchair is considered not medically necessary and, therefore, not covered.

If the manual wheelchair is considered not medically necessary, then the related accessories are also considered not medically necessary and, therefore, not covered.

More than one wheelchair is considered not medically necessary and, therefore, not covered. Backup wheelchairs are also considered not medically necessary and, therefore, not covered. If a manual wheelchair is covered, a power wheelchair or a power-operated vehicle (POV) provided at the same time is considered not medically necessary and, therefore, not covered.

A wheelchair that has been customized for purposes other than medical necessity is considered not medically necessary and, therefore, not covered. Examples of customization for purposes other than medical necessity include, but are not limited to: modification for transportation, adaptation for travel over rough terrain, and enhancement for recreational purposes.

REIMBURSEMENT INFORMATION

Codes for wheelchair reimbursement include all labor charges involved in the assembly of the wheelchair, as well as support services such as emergency services, delivery, setup, education, and ongoing assistance with the use of the wheelchair.

A loaner wheelchair may be required when repair to a medically necessary wheelchair requires the removal of the wheelchair from the individual for more than one day.
  • When repairs are required during a rental period, the Company-contracted durable medical equipment (DME) provider who supplied the rental wheelchair must supply a loaner wheelchair. The loaner wheelchair is not eligible for reimbursement.
  • When a purchased wheelchair requires repair, one month's rental of a wheelchair is considered medically necessary and, therefore, covered.
  • A loaner wheelchair should be billed using the specific code for the wheelchair being loaned.
  • Requests for loaner wheelchairs for periods longer than one month are subject to review.

For individuals requiring heavy-duty or extra heavy-duty wheelchair bases, the reimbursement for reinforced back and/or seat upholstery is included in the reimbursement for the wheelchair base.
  • Reinforced back and/or seat upholstery is not covered when used in conjunction with other manual wheelchair bases.

The following features are included in the reimbursement allowance for all adult manual wheelchairs:
  • Seat width: 15 inches to 19 inches
  • Seat depth: 15 inches to 19 inches
  • Arm style: Fixed, swingaway, or detachable; fixed height
  • Footrests: Fixed, swingaway, or detachable

Codes K0003-K0007 and E1161 include any seat height.

A wheelchair that is customized for medical necessity should be reported with the appropriate code for the wheelchair base (K0008) and the appropriate code(s) for any additional wheelchair options and/or accessories. Refer to the policy on wheelchair options and accessories for more information on the medical necessity criteria and appropriate codes to report for these features. If the frame of the wheelchair is modified in a unique way to accommodate the individual, the wheelchair should be reported with the appropriate code for the wheelchair base, and the modification(s) should be reported with the code K0108 (wheelchair component or accessory, not otherwise specified).

REPAIR AND REPLACEMENT

Requests for a different type of wheelchair due to a change in medical and/or functional status such that the individual can no longer operate his/her present manual wheelchair are considered new requests, not requests for replacement. These requests are evaluated against the medical necessity criteria for the new type of wheelchair requested.

For information on the criteria for the repair and replacement of manual wheelchairs, refer to the policy addressing the repair and replacement of durable medical equipment (DME).

REQUIRED DOCUMENTATION

All assessments performed to determine the appropriateness of a manual wheelchair must be within the prescribing professional provider's scope of practice.

The Company may conduct reviews and audits of services to our members regardless of the participation status of the provider. Medical record documentation must be maintained on file to reflect the medical necessity of the care and services provided. These medical records may include but are not limited to: records from the professional provider’s office, hospital, nursing home, home health agencies, therapies, and test reports. This policy is consistent with Medicare's documentation requirements, including the following required documentation:

PRESCRIPTION (ORDER) REQUIREMENTS
Before submitting a claim to the Company, the supplier must have on file a timely, appropriate, and complete order for each item billed that is signed and dated by the professional provider who is treating the member. Requesting a provider to sign a retrospective order at the time of an audit or after an audit for submission as an original order, reorder, or updated order will not satisfy the requirement to maintain a timely professional provider order on file.

PROOF OF DELIVERY
Medical record documentation must include a contemporaneously prepared delivery confirmation or member’s receipt of supplies and equipment. The medical record documentation must include a copy of delivery confirmation if delivered by a commercial carrier, and a signed copy of delivery confirmation by member/caregiver if delivered by the DME supplier/provider. All documentation is to be prepared contemporaneous with delivery and be available to the Company upon request.

CONSUMABLE SUPPLIES
The durable medical equipment (DME) supplier must monitor the quantity of accessories and supplies an individual is actually using. Contacting the individual regarding replenishment of supplies should not be done earlier than approximately seven days prior to the delivery/shipping date. Dated documentation of this contact with the individual is required in the individual’s medical record. Delivery of the supplies should not be done earlier than approximately five days before the individual would exhaust their on-hand supply.

HOME ASSESSMENT
Information about whether the individual's home can accommodate the wheelchair (criterion 3) also called the home assessment, must be fully documented in the medical record or elsewhere by the supplier. For manual wheelchairs, the home assessment may be done directly by visiting the individual’s home or indirectly based upon information provided by the individual or their designee. When the home assessment is based upon indirectly obtained information, the supplier must, at the time of delivery, verify that the item delivered meets the requirements specified in criterion 3. Issues such as the physical layout of the home, surfaces to be traversed, and obstacles must be addressed by and documented in the home assessment. Information from the individual’s medical record and the supplier’s records must be available upon request.

If required documentation is not available on file to support a claim at the time of an audit or record request, the durable medical equipment (DME) supplier may be required to reimburse the Company for overpayments.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, manual wheelchairs are covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.
  • A customized (including for medical necessity) wheelchair to assist or replace ambulatory functions may be a benefit contract exclusion. Individual benefits must be verified.

Adult manual wheelchairs (K0001-K0007, K009, E1161) are those that have a seat width and a seat depth of 15 inches or greater. For codes K0001-K0007 and K0009, the wheels must be large enough and positioned such that the wheelchair can be propelled by the user. Pediatric manual wheelchairs (E1229, E1231-E1238) are those that have a seat width and a seat depth of 14 inches or less. In addition, specific wheelchairs are defined by the following characteristics:
  • Standard wheelchair (K0001)
    • Wheelchair weight: Greater than 36 pounds
    • Seat height: 19 inches or greater
    • Weight capacity: 250 pounds or less
  • Standard hemi (low seat) wheelchair (K0002)
    • Wheelchair weight: Greater than 36 pounds
    • Seat height: Less than 19 inches
    • Weight capacity: 250 pounds or less
  • Lightweight wheelchair (K0003)
    • Wheelchair weight: Between 34 and 36 pounds
    • Weight capacity: 250 pounds or less
  • High-strength, lightweight wheelchair (K0004)
    • Wheelchair weight: Less than 34 pounds
    • Lifetime warranty on side frames and crossbraces
  • Ultra-lightweight wheelchair (K0005)
    • Wheelchair weight: Less than 30 pounds
    • Adjustable rear axle position
    • Lifetime warranty on side frames and crossbraces
  • Heavy-duty wheelchair (K0006)
    • Weight capacity: Greater than 250 pounds
  • Extra heavy-duty wheelchair (K0007)
    • Weight capacity: Greater than 300 pounds
  • Custom manual wheelchair base (K0008)
    • Modified for a specific individual with physical and functional deficits, that cannot be met with a standard wheelchair.
  • Adult tilt-in-space wheelchair (E1161)
    • Ability to provide pressure relief and postural support by tilting the frame of the wheelchair greater than or equal to 45 degrees from horizontal while maintaining its seat-to-back angle
    • Lifetime warranty on side frames and crossbraces

Wheelchair weight represents the weight of the standard configuration of the wheelchair with a seat and back but without frontriggings.

A manual wheelchair is considered customized if it has been upgraded, constructed, or modified in any way that is not based on medical necessity. A customized manual wheelchair may be a benefit contract exclusion. Individual benefits must be verified.

Home is defined as the individual's place of residence (eg, private residence/domicile, assisted living facility, long-term care facility, skilled nursing facility [SNF] at a custodial level of care). Requests for manual wheelchairs for individuals residing in a long-term care facility or an SNF are evaluated against medical necessity criteria as well as benefit and provider contracts.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

The FDA has approved several manual wheelchairs and considers them Class II or III devices.

Description

Manual wheelchairs are devices used to assist adults and children in the mobility-related activities of daily living (MRADLs). A manual wheelchair may be rigid or folding, has two wheels sized and placed so the user may propel the chair, and is available in a range of sizes. A manual wheelchair may be standard or specialized. A specialized manual wheelchair is designed for the individual with extensive mobility requirements or positioning needs.

Manual wheelchairs are components of a category of durable medical equipment (DME) known as mobility assistive equipment (MAE). MAE includes, but is not limited to: canes, crutches, walkers, manual wheelchairs, rolling chairs, power wheelchairs, and power-operated vehicles. There is wide variability in functional status among individuals who may benefit from MAE. Providers must assess an individual's physical and psychological status, the availability of other support (ie, the presence of a caregiver), and the physical characteristics of the individual's home (eg, private residence/domicile, assisted living facility, long-term care facility, skilled nursing facility at a custodial level of care) to determine which type of MAE is most appropriate.

Certain MRADLs such as toileting, feeding, dressing, grooming, and bathing customarily take place in specific locations within the home. If mobility limitations negatively impact the individual's ability to participate in these activities in their customary locations within the home, and/or accomplish them in a timely and safe manner, the use of MAE may be considered appropriate to facilitate performance of MRADLs.
References


Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). 280.3: Mobility assistive equipment (MAE). [CMS Web site]. 05/05/05. Available at: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=219&ncdver=2&DocID=280.3&bc=gAAAABAAAAAA&. Accessed December 20, 2017.

Noridian Healthcare Solutions, LLC. Local Coverage Determination (LCD). L33788: Manual wheelchair bases. Effective 01/01/2017. Available at: https://med.noridianmedicare.com/documents/2230703/7218263/Manual+Wheelchair+Bases+LCD+and+PA/f3a561bd-5e6a-45fe-a227-4514e15c3c93 Accessed December 20, 2017.

Noridian Healthcare Solutions, LLC. Policy Article A52497. Manual wheelchair bases. Effective 01/01/2017. Available at: https://med.noridianmedicare.com/documents/2230703/7218263/Manual+Wheelchair+Bases+LCD+and+PA/f3a561bd-5e6a-45fe-a227-4514e15c3c93 Accessed December 20, 2017.





Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

N/A


HCPCS Level II Code Number(s)



MEDICALLY NECESSARY

E1031 Rollabout chair, any and all types with castors 5 in or greater

E1037 Transport chair, pediatric size

E1038 Transport chair, adult size, patient weight capacity up to and including 300 pounds

E1039 Transport chair, adult size, heavy-duty, patient weight capacity greater than 300 pounds

E1050 Fully-reclining wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1060 Fully-reclining wheelchair, detachable arms, desk or full-length, swing-away detachable elevating legrests

E1070 Fully-reclining wheelchair, detachable arms (desk or full-length) swing-away detachable footrest

E1083 Hemi-wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests

E1084 Hemi-wheelchair, detachable arms, desk or full-length arms, swing-away detachable elevating legrests

E1085 Hemi-wheelchair, fixed full-length arms, swing-away detachable footrests

E1086 Hemi-wheelchair, detachable arms, desk or full-length, swing-away detachable footrests

E1087 High strength lightweight wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1088 High strength lightweight wheelchair, detachable arms desk or full-length, swing-away detachable elevating legrests

E1089 High-strength lightweight wheelchair, fixed-length arms, swing-away detachable footrest

E1090 High-strength lightweight wheelchair, detachable arms, desk or full-length, swing-away detachable footrests

E1092 Wide heavy-duty wheel chair, detachable arms (desk or full-length), swing-away detachable elevating legrests

E1093 Wide heavy-duty wheelchair, detachable arms, desk or full-length, swing-away detachable footrests

E1100 Semi-reclining wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1110 Semi-reclining wheelchair, detachable arms (desk or full-length) elevating legrest

E1130 Standard wheelchair, fixed full-length arms, fixed or swing-away detachable footrests

E1140 Wheelchair, detachable arms, desk or full-length, swing-away detachable footrests

E1150 Wheelchair, detachable arms, desk or full-length swing-away detachable elevating legrests

E1160 Wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1161 Manual adult size wheelchair, includes tilt in space

E1170 Amputee wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1171 Amputee wheelchair, fixed full-length arms, without footrests or legrest

E1172 Amputee wheelchair, detachable arms (desk or full-length) without footrests or legrest

E1180 Amputee wheelchair, detachable arms (desk or full-length) swing-away detachable footrests

E1190 Amputee wheelchair, detachable arms (desk or full-length) swing-away detachable elevating legrests

E1195 Heavy-duty wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1200 Amputee wheelchair, fixed full-length arms, swing-away detachable footrest

E1220 Wheelchair, specially sized or constructed (indicate brand name, model number, if any, and justification)

E1221 Wheelchair with fixed arm, footrests

E1222 Wheelchair with fixed arm, elevating legrests

E1223 Wheelchair with detachable arms, footrests

E1224 Wheelchair with detachable arms, elevating legrests

E1229 Wheelchair, pediatric size, not otherwise specified

E1231 Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system

E1232 Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system

E1233 Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system

E1234 Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system

E1235 Wheelchair, pediatric size, rigid, adjustable, with seating system

E1236 Wheelchair, pediatric size, folding, adjustable, with seating system

E1237 Wheelchair, pediatric size, rigid, adjustable, without seating system

E1238 Wheelchair, pediatric size, folding, adjustable, without seating system

E1240 Lightweight wheelchair, detachable arms, (desk or full-length) swing-away detachable, elevating legrest

E1250 Lightweight wheelchair, fixed full-length arms, swing-away detachable footrest

E1260 Lightweight wheelchair, detachable arms (desk or full-length) swing-away detachable footrest

E1270 Lightweight wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1280 Heavy-duty wheelchair, detachable arms (desk or full-length) elevating legrests

E1285 Heavy-duty wheelchair, fixed full-length arms, swing-away detachable footrest

E1290 Heavy-duty wheelchair, detachable arms (desk or full-length) swing-away detachable footrest

E1295 Heavy-duty wheelchair, fixed full-length arms, elevating legrest

K0001 Standard wheelchair

K0002 Standard hemi (low seat) wheelchair

K0003 Lightweight wheelchair

K0004 High strength, lightweight wheelchair

K0005 Ultralightweight wheelchair

K0006 Heavy-duty wheelchair

K0007 Extra heavy-duty wheelchair

K0008 Custom Manual Wheelchair Base

K0009 Other manual wheelchair/base


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References


Policy History

Revisions from 05.00.12g
09/26/2018This policy has been reissued in accordance with the Company's annual review process.
12/27/2017The medical necessity criteria was revised for the following codes:
  • K0005, K0008, E1037, E1038, E1039, E1031, E1161.

The following codes were removed from this policy. Please refer to the policy on Patient Lifts for coverage:
    • E1035, E1036


Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 12/27/2017
Version Issued Date: 12/27/2017
Version Reissued Date: 09/26/2018

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.