Medical or Coverage Policy means a statement developed by Arkansas Blue Cross and Blue
Shield that sets forth the medical criteria for coverage under an Arkansas Blue
Cross Evidence of Coverage. Some limitations of benefits related to coverage, drug,
treatment, service equipment or supply are also outlined in the Coverage Policy.
The existence of an affirmative Coverage Policy does not certify coverage, nor does
it override or replace specific coverage language listed in an individual policy
or group health plan. While a procedure, technology or drug may be medically necessary,
it still may be specifically excluded under the terms of a member's contract or
benefit plan, or the use may be an investigational or experimental use of the service
and therefore excluded under the experimental or investigational language of the
member's benefit contract or plan.
The absence of a specific coverage policy does not indicate that a service is covered.
For example, a new device or a new use of an old device may not have been proven
safe and effective, but coverage may also have not been previously requested, thereby
providing us an opportunity to study the information on the safety and effectiveness
of the new use of the device.
A copy of a specific Coverage Policy is available from Arkansas Blue Cross and Blue
Shield upon request at no cost, or a Coverage Policy can be reviewed on the Arkansas
Blue Cross and Blue Shield website at www.ArkansasBlueCross.com.
The Arkansas Blue Cross and Blue Shield medical directors, including the regional
medical directors, review each Coverage Policy before the policies are implemented.
Input is requested from local physicians on each new Coverage Policy. Each existing
coverage policy is reviewed for accuracy every two years if the policy restricts
coverage of a service, procedure, device or drug.
The following sources of information are consulted for the development of Coverage
Policies regarding new or emerging treatments, procedures, devices or drugs:
A similar process is followed for additional new uses of established procedures,
devices or drugs to establish Coverage Policies.
Current Procedural Terminology (CPT) is a five-digit code for reporting of treatment
and diagnostic services performed by physicians. CPT is protected by copyright and
trademark owned by the American Medical Association (AMA). Physicians use CPT codes
in billing for their services.
Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas.
Copyright © 2001-2017 Arkansas Blue Cross and Blue Shield