 Blue Cross Long Term Plans
Blue Cross Long Term Plans provides network access and related services under long term health benefit plans. Payors may be insurance companies or self-insured employers, trusts or governments. The benefits for medical services are paid directly by the payor or on behalf of the payor using payor funds.
Utilization management services provided by Blue Cross are the process by which reviews on the benefits of medical services or supplies are made. Blue Cross of California's medical necessity recommendations is utilized by the purchaser to make benefit determinations. The administrator of the benefit policy keeps the authority with regard to eligibility, coverage and the benefits under the benefit plan. Members usually are provided specific coverage information by the local customer care representatives. Coverage recommendations are subject to all terms and conditions of the existing beneficiary policy. Blue Cross Long Term medical policies do not comprise medical advice or medical care.
Medical technology is gradually evolving and the different medical policies can change without notice. Blue Cross of California may provide advance notice of changes even if it has a negative impact on claims payment. Blue Cross of California has no control or right of control over doctors, nurses and other providers
|
