Welcome to the Medical Policy homepage of the Blue Cross Blue Shield of Wisconsin's Website.

Welcome to the Blue Cross Blue Shield of Wisconsin Medical Policy website. By placing these medical policies on our website, we are taking advantage of an important opportunity to share the information used in making coverage determinations. Please note that the medical policies contained on this website are designed to be an informational resource for both physicians and other healthcare practitioners and members, and should not be interpreted as an authorization, or an explanation of benefits or contracts.

Due to the continuing evolution of technology, existing policies are routinely updated and subject to change. In the future, these new and revised policies will be summarized in the "What’s New" section of the website.

The medical policies are designed to be a guide to coverage decisions. However, since all patients are individuals, actual coverage decisions are made individually, based on a patient’s unique clinical circumstances, specific health insurance contract and range of benefits. For example, specific contract language, State or Medicare/Medicaid mandates will always supersede these medical policies.

Wellpoint’s Medical Policy and Technology Assessment Committee provides guidance and validation of the medical policies. This Committee consists of physicians from various geographic areas throughout the country, including physicians in academic medicine, physicians practicing in the community and participating in our networks, and medical directors. The Committee meets three to four times per year to consider reports on new treatments, procedures and devices, which are developed by physician staff and consultants for the medical policy department. The reports are based on an evaluation of the evidence as reported in the peer-reviewed medical literature, minutes from Federal Drug Administration advisory committee hearings, and referenced policy statements and practice guidelines issued by relevant medical specialty societies and federal health policy entities. In addition, other expert organization’s technology assessments may be reviewed. Based on this data, the Medical Policy and Technology Assessment Committee makes a determination regarding the investigational status and medical necessity of each technology, which is then summarized in the subsequent medical policy. Activities and decisions of this Committee are reported to the Physicians Relations Committee who oversee this activity for Blue Cross Blue Shield of Wisconsin.

Each medical policy consists of a description section, a statement of the medical policy itself (i.e. investigational, medically necessary or not medically necessary), a listing of patient selection criteria, if appropriate, and a listing of the most relevant references, accessed through the printed medical literature or as posted on the Internet.

To search for a particular medical policy, click on "Search" and then type the policy name or a descriptive word and then click on "Search."

We welcome your comments and questions. To provide us with your input or to ask a question about a medical policy, click on "Contact Us," and then click on the e-mail link. We will respond to your inquiry within 3 business days. It is our hope that you will find our new web site informative and helpful.