Corporate Medical Policies
Medical Mutual Corporate Medical Policies Disclaimer
Medical Mutual has developed Corporate Medical Policies (the “Policies”)
that offer guidance and support for benefit determinations. Benefit plans vary
in coverage and some plans may not provide coverage for some services discussed
in these Policies. The Policies have been developed to assist in administering
plan benefits. Benefit determinations and coverage decisions are subject to all
the terms and conditions of the applicable benefit plan, including definitions,
specific inclusions or exclusions, and applicable state or federal laws.
The Policies are considered guidelines only and not intended to infer benefits or
coverage for a specific member. Benefit determinations are based on the
specific facts of the member’s case. If a member disagrees with a benefit
determination, a member is afforded the right to appeal that decision.
The Policies do not constitute medical advice or medical care. The healthcare
provider treating the member is solely responsible for the medical advice and
treatment rendered to the member. Medical Mutual coverage decisions or benefit
determinations are benefit decisions only.
Medical Mutual is not responsible for, does not provide, and does not represent itself as a provider
of medical care. Medical Mutual members should discuss the information in
the Policies with the treating healthcare provider. Only the treating provider
can provide medical care and be responsible for the quality or appropriateness
of the medical care provided and the skill with which it is provided. If a
service or supply is not eligible for benefits, a member and the treating
provider may proceed with that service or supply, however, benefits are not
available under the plan.
The Policies are regularly reviewed, updated, modified,
supplemented, withdrawn and added and are, therefore, subject to change.
Benefit determinations are made in the context of medical policies existing at
the time the determination is made and are not subject to later revision as a
result of a change in medical policy.
I acknowledge that I have read and understand the
foregoing Medical Mutual Disclaimer.
I accept these terms and conditions