Medical Mutual - Health Plans for Life

Corporate Medical Policies

Medical Mutual Corporate Medical Policies Disclaimer

Medical Mutual has certain Corporate Medical Policies (the “Policies”) that offer guidance for benefit determinations. The Policies have been developed to assist in administering plan benefits. Benefit plans vary in coverage and some plans may not provide coverage for some services discussed in these Policies. Benefit determinations and coverage decisions are subject to all terms and conditions of the applicable benefit plan, including definitions, specifically stated benefits, exclusions and benefit limitations and applicable state or federal laws.

Policies are considered guidelines and are not intended to infer or eliminate benefits or coverage for a specific member. Benefit determinations are based on the specific facts of each member’s case. If a member disagrees with a benefit determination, the member is afforded the right to appeal that decision.

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 members should discuss information included in the Policies with the treating healthcare provider. Only the treating provider can deliver medical care and be responsible for the quality or appropriateness of the medical care and the skill with which it is provided.

Medical Mutual coverage decisions are benefit decisions only. Medical Mutual is not responsible for, does not provide and does not represent itself as a provider of medical care. If a service or supply is not eligible for benefits as determined by Medical Mutual, a member and the treating provider may proceed with that service or supply; however, benefits will not be available under the member’s plan.

Policies are regularly reviewed, updated, withdrawn or added and therefore, subject to change.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.

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