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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 |
|---|---|---|---|---|---|
| 13.004.002 | Periodontal non-Surgical Services | Oct 24, 2024 | Policy Archived | All periodontal treatments need predetermination of benefits and the treatment plan for evaluation, should be... | Ver |
| 13.005.001 | Dental Implants | Oct 24, 2024 | Oct 20, 2025 | 1. there must be bone integration of the implant, to be able move to the prosthesis phase of crowns,... | Ver |
| 13.005.002 | Implant Services; Crowns, bridges (retainers and Pontics) and Prostheses Supported by Implants | Oct 24, 2024 | Oct 20, 2025 | 1. crowns should be predetermined and are subject to the corresponding coinsurances and caps. 2. the... | Ver |
| 13.006.001 | Visit to Ambulatory Surgical Center and / or Hospital | Nov 11, 2020 | Policy Archived | Code d9420 requires predeterminationand the required documents are; (a) patient’s diagnostic (b)... | Ver |
| 13.007.001 | Maxillofacial Prosthesis | Oct 24, 2024 | Policy Archived | The maxillofacial prosthesis services require predetermination. 1. the maxillofacial prosthesis services... | Ver |
| 13.008.001 | Frenectomy | Oct 26, 2023 | Policy Archived | 1.requires predetermination. 2.the predetermination must be accompanied by the evaluation and... | Ver |
| 13.009.001 | Maxillary Obturators | Aug 22, 2023 | Policy Archived | These services are covered for all patients that have a palatal or nasopharyngeal defect that impairs the... | Ver |
| 13.009.002 | Oral Surgical Splint, Impression and Preparation | Nov 11, 2020 | Policy Archived | This service is considered as surgical guidance and stabilization for orthognathic surgery (surgical... | Ver |
| 13.009.003 | Orthognathic Surgery | Oct 24, 2024 | Oct 20, 2025 | These surgeries may be recognized for payment as long as one of the following criteria is met:... | Ver |
| 13.009.004 | Temporomandibular Joint Disorder | Mar 05, 2024 | Mar 20, 2025 | Diagnostic procedures the following diagnostic procedures may be considered medically necessary in the... | Ver |
| 13.010.001 | Orthodontic Services | Oct 24, 2024 | Policy Archived | 1. that sufficient functional disability be present as a result of disease, trauma, congenital anomalies... | Ver |
| 7.001.168 | Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial Fibrillation | Sep 07, 2022 | Sep 07, 2023 | The use of surgical left atrial appendage occlusion devices, including the atriclip device, for stroke... | Ver |
| M3.001.001 | Therapeutic Radiopharmaceuticals for Prostate Cancer | Aug 22, 2024 | Aug 20, 2025 | Therapeutic radiopharmaceuticals for prostate cancer using lutetium (lu) 177 vipivotide tetraxetan... | Ver |
| M5.001.001 | Viscosupplementation Therapy For Knee | May 10, 2024 | May 20, 2025 | Viscosupplementation therapy is part of the therapy used in the treatment of osteoarthritis of the knee.... | Ver |
| M5.001.002 | Rituximab | May 10, 2024 | May 20, 2025 | Rituximab is a genetically engineered chimeric murine/human monoclonal igg1 kappa antibody directed against... | Ver |
| M5.001.003 | Trastuzumab – Trastuzumab Biologics | May 10, 2024 | May 20, 2025 | Trastuzumab is a monoclonal antibody, one of a group of drugs designed to attack specific cancer cells.... | Ver |
| M5.001.005 | Bevacizumab – Bevacizumab Biologics for Oncologic Uses | May 10, 2024 | May 20, 2025 | Bevacizumab is a humanized monoclonal antibody directed against vascular endothelial growth factor a... | Ver |
| M5.001.006 | CSF Hematopoietic Colony Stimulating Factors | May 10, 2024 | May 20, 2025 | White blood cell growth factors, also known as granulocyte colony stimulating factors (g-csf), are... | Ver |
| M5.001.007 | Somatuline® Depot; Lanreotide | May 10, 2024 | May 20, 2025 | Somatuline® depot; lanreotide may be considered medically necessary in patients 18 years of age or older... | Ver |
| M5.001.008 | Simponi ARIA® (golimumab) | May 10, 2024 | May 20, 2025 | Simponi aria® (golimumab) may be considered medically necessary in patients is at least 18 years of... | Ver |
