How we determine new health services
We keep up with changes in health care through an ongoing review of new services, procedures and drug treatments. Our goal is to make coverage decisions in the best interest of our members’ health.
A committee of Blue Care Network physicians, nurses and representatives from different areas in the company is responsible for reviewing new technology requests and making recommendations. In our research we use a variety of resources, which may include:
- Published scientific studies from peer-reviewed medical literature or comparable sources
- Recommendations from the facility or physician proposing to perform the procedure or test
- The U.S. Food and Drug Administration
- The National Institute of Health
- The National Cancer Institute
- Other medical sources as appropriate, including national and local Medicare and state Medicaid coverage guidelines
- The Blue Cross and Blue Shield Association
After reviewing the literature, the committee makes a recommendation to BCN’s senior vice president and chief medical officer about including the service, procedure or drug treatment as a benefit.
page modified 04/27/2008