| Medical
Policy and Behavioral Health Policy -- Terms
and Conditions
By viewing the Medical Policy and Behavioral Health
Policy manuals at: http://blue.regence.com/trgmedpol/intro.html,
you understand and agree to the following terms and
conditions:
Description
The Medical Policy and Behavioral Health
Policy manuals contain policies approved by Asuris.
Medical policies are based upon scientific evidence
of merit for a particular medical technology.
Use
Asuris uses medical and behavioral health policies
as guidelines for coverage determinations in all health
care insurance products, unless otherwise indicated.
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 Asuris, but
may be used for purposes related to the health care
of a Asuris Plan member. You are strictly
prohibited from using Medical Policies for purposes
not related to the health care of a Asuris Plan
member, including but not limited to commercial use.
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