By continuing to
the medical policy manual, you understand and
agree to the following terms and conditions:
Medical Policy Manual Terms and Conditions
Description
The Medical Policy Manual contains Medical
Policies approved by the Medical Policy Workgroup. Medical Policies are
based upon scientific evidence of merit for a particular
medical technology. Technology determinations are made
using criteria developed by the BlueCross BlueShield
Association's® Technology Evaluation Center.
Use
Our Plans and any of their affiliated or subsidiary companies use Medical Policies as guidelines for coverage determinations in their respective health care insurance products, unless otherwise indicated. The applicable Medical Policy is the policy that is in effect at the time of service.
Conflict with Plan Documents
In the event of a conflict between Medical Policy and
any Plan document under which a member is entitled
to Covered Services, the Plan document will govern.
Plan documents include, but are not limited to, Subscriber
Contracts, Summary Plan Documents, and other coverage
documents prepared by a Plan.
Restrictions and Limitations
- Medical Policies DO NOT determine the schedule
of benefits. Rather, Medical Policies are used in
the process of determining whether a service may
be medically necessary or investigational.
- Medical Policies are interpreted and applied in
the sole discretion of the Plan.
- Medical Policy application is subject to state
and federal laws and specific instructions from Plan
Sponsors of self-insured groups.
- Medical Policies DO NOT constitute medical advice
and DO NOT guarantee any results
or outcomes. You
should discuss any health care questions related
to these Medical Policies with your health care provider.
- Current Procedural Terminology (CPT®) codes
and descriptions are the property of the American
Medical Association with all rights reserved.
- Medical Policies are the property of our Plans and any of their affiliated or subsidiary companies, but
may be used for purposes related to the health care
of a Plan member. You are strictly
prohibited from using Medical Policies for purposes
not related to the health care of a Plan
member, including but not limited to commercial use.
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