We strive to cover procedures, treatments, devices and drugs proven to be safe and effective for a particular disease or condition and continually look at new medical advances and technology to determine for coverage and payment purposes if any is superior to those already in use. To aid in the decision-making for the development of these Medical Policies (Medical Coverage Guidelines), we consult expert sources, such as the views of physicians practicing in the relevant clinical area, review of clinical studies published in respected scientific journals and the opinions from various specialty medical organizations. We provide our Medical Policies (Medical Coverage Guidelines) to our members, physicians and providers so that you are apprised of the criteria used in determining coverage for payment purposes. Click on the link below to access our Medical Policies (Medical Coverage Guidelines).

• Medical Policies (Medical Coverage Guidelines) (external website)

Please have your patient refer to his or her contract, Evidence of Coverage, member handbook, certificate of coverage, or endorsement or rider, if applicable, to determine coverage. If your patient is unsure about particular coverage/benefits or has questions, please have the member call the Customer Service number on his or her ID card.

Additional Resources:

• InterQual® (IQ) Transparency Tool
• American Specialty Health, Inc. (Chiropractic)
• Florida Health Care Plan Inc (FHCP)
• Lucet (Behavioral Health)
• New Century Health (Oncology & Cardiology)