Medical and Drug Policies

Please read the terms and conditions below carefully.

UnitedHealthcare has developed Medical Policies and Medical Benefit Drug Policies to assist us in administering health benefits. These policies are provided for informational purposes and do not constitute medical advice. Treating physicians and health care providers are solely responsible for determining what care to provide to their patients. Members should always consult their physician before making any decisions about medical care.

Our Medical Policies and Medical Benefit Drug Policies express our determination of whether a health service (e.g., test, device, or procedure) is proven to be effective based on the published clinical evidence. They are also used to decide whether a given health service is medically necessary. Services determined to be experimental, investigational, unproven, or not medically necessary by the clinical evidence are typically not covered.

Benefit coverage for health services is determined by the specific benefit plan. When deciding coverage, the federal, state, or contractual requirements for benefit plan coverage must be referenced. In the event of a conflict, the federal, state, or contractual requirements for benefit plan coverage supersede these policies.

Medical Policies and Medical Benefit Drug Policies are developed as needed, regularly reviewed and updated, and subject to change. They represent a portion of the resources used to support UnitedHealthcare coverage decision making. The information presented in these policies is believed to be accurate and current as of the date of publication and is provided on an "AS IS" basis. Additionally, UnitedHealthcare may use tools developed by third parties, such as the InterQual^® criteria, to assist us in administering health benefits. UnitedHealthcare Medical Policies and Medical Benefit Drug Policies are intended to be used in connection with the independent professional medical judgment of a qualified health care provider and do not constitute the practice of medicine or medical advice.

Medical Policies and Medical Benefit Drug Policies are the property of UnitedHealthcare. Unauthorized copying, use, and distribution of this information are strictly prohibited. The InterQual^® criteria are proprietary to Change Healthcare and are not published on this website.

When these policies are used to determine medical necessity, clinical guidelines will be applied in the following order:

1. State/Federal Guidelines and Contract Requirements
2. InterQual^® criteria
3. UnitedHealthcare Community Plan of Indiana Medical & Drug Policies

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