Políticas Médicas
Las políticas médicas son documentos que definen el reconocimiento de cubierta para tecnologías, procedimientos y tratamientos. Las declaraciones de necesidad médica en las políticas, sobre si una tecnología, procedimiento, tratamiento, suplido, equipo, medicamento u otro servicio mejora el resultado en la salud de la población para la cual dicha tecnología o tratamiento fue diseñado se basan en evidencia científica, estudios clínicos y opiniones profesionales de nuestros proveedores y de las organizaciones médicas reconocidas.
Cada documento desplegado en este sitio Web se provee con propósitos informativos solamente y no es una autorización, explicación de beneficios o un contrato. El recibir beneficios está sujeto a la satisfacción de todos los términos y condiciones de la cubierta. La tecnología médica cambia constantemente y nos reservamos el derecho de revisar y actualizar nuestras políticas periódicamente.
| ID | Título | Última Revisión | Siguiente Revisión | Descripción | Acceso |
|---|---|---|---|---|---|
| 10.001.014 | TELEMEDICINE | Oct 26, 2023 | Oct 20, 2024 | Numerous states have enacted laws regarding coverage of health care services delivered through telemedicine... | Ver |
| 10.001.026 | GLUCOMETERS AND SUPPLIES | Nov 14, 2018 | Policy Archived | To be eligible for coverage of related supplies and accessories, and blood glucose monitors, the member must... | Ver |
| 10.002.001 | CHIROPRACTIC SERVICES | Feb 25, 2022 | Policy Archived | Chiropractic services may be considered medically necessary when all of the following criteria are met:... | Ver |
| 10.002.002 | SERVICIOS DE SICOLOGOS CLINICOS | Dec 26, 2017 | Policy Archived | Triple-s considera para pago servicios ambulatorios e intrahospitalarios, diagnósticos y terapéuticos, que... | Ver |
| 10.002.003 | SERVICIOS DE OPTOMETRIA | Aug 22, 2017 | Policy Archived | Se consideran para pago los servicios por optómetras para aquellas pólizas que así lo estipulen. estos... | Ver |
| 10.002.006 | OSTEOPATHY DOCTORS’ SERVICES | Jul 13, 2022 | Policy Archived | The doctor in osteopathy is authorized to practice osteopathy by the medical licensing and discipline board... | Ver |
| 10.002.009 | SERVICIOS DE AUDIOLOGIA | May 11, 2016 | Policy Archived | Triple-s cubrirá las pruebas de audiología ambulatoria en niños y adultos cuando éstas sean requeridas y... | Ver |
| 10.002.010 | Acupuncture | Apr 20, 2022 | Policy Archived | Acupuncture may be considered medically necessary for treatment of the following conditions: 1. chronic... | Ver |
| 10.002.011 | Alternative and Naturopatic | Nov 14, 2018 | Policy Archived | Triple-s will recognize for payment the services provided by doctors in naturopathy, licensed in puerto rico.... | Ver |
| 11.001.001 | Autologous blood transfusion (Cell Saver) | Sep 29, 2022 | Policy Archived | The self-transfusion "cell savers" is considered for payment in the following surgeries: a. general... | Ver |
| 11.001.003 | Anti-CCP Testing for Rheumatiod Arthritis | May 13, 2019 | Policy Archived | Measurement of anti-ccp may be considered medically necessary when used as part of the diagnostic workup for... | Ver |
| 11.001.004 | MARCADORES DE TUMORES SERICOS PARA CANCER DE MAMA Y GASTROINTESTIL | Sep 21, 2016 | Policy Archived | Determinaciones de marcadores de tumor ca72-4, ca19-9 y ca27.29 no se consideran para pago como una técnica... | Ver |
| 11.001.005 | In Vitro Chemoresistance and Chemosensitivity Assays | Sep 09, 2021 | Policy Archived | In vitro chemoresistance assays, including, but not limited to, extreme drug resistance assay, are considered... | Ver |
| 11.001.006 | Testing for Helicobacter pylori Infection | Feb 21, 2023 | Policy Archived | Urea breath testing or fecal antigen testing may be considered medically necessary as part of the workup of... | Ver |
| 11.001.007 | Identification of Microorganisms Using Nucleic Acid Probes | Jul 10, 2023 | Jul 20, 2024 | The use of nucleic acid testing using a direct or amplified probe technique (without quantification of viral... | Ver |
| 11.001.009 | Noninvasine Techniques for the Evaluation and Monitoring of Patients with Chronic Liver Disease | Dec 13, 2023 | Dec 20, 2024 | A single fibrosure multianalyte assay may be considered medically necessary for the evaluation of patients... | Ver |
| 11.001.010 | ALFA-FETOPROTEI EN LA DETECCION DE CANCER HEPATOCELULAR | May 12, 2016 | Policy Archived | El alfa-fetoproteína para detección de cáncer hepatocelular no se considera para... | Ver |
| 11.001.011 | Serum Biomarker Human Epididymis Protein 4 | Jan 19, 2024 | Jan 20, 2025 | Measurement of human epididymis protein 4 is investigational for all indications.... | Ver |
| 11.001.012 | JAK2, MPL, and CALR, Testing for Myeloproliferative Neoplasms | Sep 12, 2023 | Sep 20, 2024 | Jak2 testing may be considered medically necessary in the diagnosis of individuals presenting with... | Ver |
| 11.001.013 | Urinary Biomarkers for Cancer Screening, Diagnosis, and Surveillance | Jan 09, 2024 | Jan 20, 2025 | The use of urinary tumor markers is considered investigational in the screening, diagnosis of, and... | Ver |
