Medical and reimbursement policies
The information at the links below is intended for use by those that provide health care services to members.
View tools we use to administer your health plan
Our Medical & Drug Policies and Coverage Determinations Guidelines(Opens new window) are tools we use to help us administer health benefits under your plan. Please consult your benefit plan document to find out what services are covered under your plan.
Consult with your health care provider for medical advice
These policies and guidelines are not medical advice. You should always consult with your physician or other health care provider about your medical care and treatment.
Search by area of the body of type of condition
For information on your medical care by condition, search by area of the body or type of condition.
How health care providers are paid
Our Reimbursement Policies(Opens new window) are one factor that determines how physicians and other health care providers are paid. More information about these policies and guidelines are available at the links above.
If you received a letter saying your coverage request was denied
You may have received a letter saying that your coverage request was denied. InterQual or MCG guidelines may have been used to make that decision.