Medical Policies

MedCost believes all our health plan members should have fair and equal access to safe, effective care. 

Our Medical Policies are guidelines that assist us in making coverage and medical necessity decisions. These policies have been developed to be consistent with evidence-based literature selected by MedCost that focuses on specific medical, pharmacy, devices, and behavioral health services, including new and emerging technologies or the application of existing technologies. 

Medical Policies are designed to be used by our professional staff when making decisions. We are making these policies available for informational purposes. Medical Policies are not a substitute for obtaining medical advice. Physicians and other health care providers are expected to exercise their medical judgment in providing the most appropriate care to members. For full understanding, we recommend that health plan members review Medical Policies with their provider(s).

Medical Policies apply only to health benefit plans administered by MedCost Benefit Services. They are regularly updated and are subject to change without notice. In the event of conflicting information between MedCost Medical Policy and a member’s Summary Plan Description (SPD), the SPD will govern unless language within the SPD explicitly defers to Medical Policy. 

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