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Medical Policy

By continuing to the medical policy manual, you understand and agree to the following terms and conditions:

Medical Policy Manual Terms and Conditions

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.

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.
Continue to the Medical Policy Manual Go to the Medical Policy Manual