The policies below summarize BMC HealthNet Plan's clinical coverage criteria for specific clinical services. These policies are used as a guide by the Plan's professional staff for clinical determinations in connection with health care coverage decisions. Clinical coverage criteria policies address new technology, treatment approaches and diagnostic and therapeutic procedures. Medical technology is continuously evolving, and the Plan's clinical coverage undergoes regular updates.
Benefits and eligibility are determined before clinical coverage policies are applied to any claim. As a result, adherence to these clinical policies does not guarantee payment when a member is ineligible or a non-covered benefit is rendered.
The definitions used throughout these policy statements have been centralized into a single location. These may be accessed through the below link:
Standard Definitions
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