Forms neuro physiotherapy jobs and brochures – medicare advantage plans

Health net’s national medical policies (the policies) are developed to assist health net in administering plan benefits neuro physiotherapy jobs and determining whether a particular procedure, drug, service, or supply is medically necessary. The policies are based upon a review of the available neuro physiotherapy jobs clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the member’s contract, including medical necessity requirements. Health net may use the policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. The member’s contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps. The policy provides for clearly written, reasonable and current criteria that have been approved by health neuro physiotherapy jobs net’s national medical advisory council (MAC). The clinical criteria and medical policies provide guidelines for determining neuro physiotherapy jobs the medical necessity criteria for specific procedures, equipment and services. In order to be eligible, all services must be medically necessary and otherwise defined in neuro physiotherapy jobs the member’s benefits contract as described in this important notice disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy neuro physiotherapy jobs guidelines and applicable contract language, the contract language prevails. Medical policy is not intended to override the policy that neuro physiotherapy jobs defines the member’s benefits, nor is it intended to dictate to providers how to neuro physiotherapy jobs practice medicine.

The date of posting is not the effective date of neuro physiotherapy jobs the policy. The policy is effective as of the date determined by neuro physiotherapy jobs health net. All policies are subject to applicable legal and regulatory mandates neuro physiotherapy jobs and requirements for prior notification. If there is a discrepancy between the policy effective date neuro physiotherapy jobs and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. In some states, prior notice or posting on the website is required before neuro physiotherapy jobs a policy is deemed effective. For information regarding the effective dates of policies, contact your provider representative. The policies do not include definitions. All terms are defined by health net. For information regarding the definitions of terms used in the neuro physiotherapy jobs policies, contact your provider representative.

Statutory notice to members: the materials provided to you are guidelines used by this neuro physiotherapy jobs plan to authorize, modify or deny care for persons with similar illnesses or neuro physiotherapy jobs conditions. Specific care and treatment may vary depending on individual need neuro physiotherapy jobs and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the policies, but rather is subject to the facts of the individual neuro physiotherapy jobs clinical case, terms and conditions of the member’s contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the member’s contract (also known as the benefit contract, coverage document, or evidence of coverage) conflicts with the policies, the member’s contract shall govern.

California health and safety code 1367.6 requires treatment for breast cancer to cover prosthetic devices neuro physiotherapy jobs or reconstructive surgery to restore and achieve symmetry for the neuro physiotherapy jobs patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject neuro physiotherapy jobs to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms neuro physiotherapy jobs and conditions applicable to other benefits. Mastectomy means the removal of all or part of the neuro physiotherapy jobs breast for medically necessary reasons, as determined by a licensed physician and surgeon.

Policies specifically developed to assist health net in administering medicare neuro physiotherapy jobs or medicaid plan benefits and determining coverage for a particular neuro physiotherapy jobs procedure, drug, service, or supply for medicare or medicaid members shall not be neuro physiotherapy jobs construed to apply to any other health net plans and neuro physiotherapy jobs members. The policies shall not be interpreted to limit the benefits neuro physiotherapy jobs afforded medicare and medicaid members by law and regulation. Continue

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