If your physician is considering surgeries or treatment employing new technology or representing a new use of existing technology, your HMSA participating provider must obtain precertification from HMSA to consider the service for coverage. The service won’t be covered if your treatment doesn’t meet HMSA’s payment determination criteria. For more information about the precertification process, please review Submitting a precertification request.
To keep pace with change, HMSA’s Technology Evaluation Committee (composed of doctors and professional analysts) uses scientific evidence to evaluate developments in technology and new application of existing technologies. The Technology Evaluation Committee uses research from sources such as professional medical journals, government agencies, national resources and guidelines, and findings from the Blue Cross and Blue Shield Association’s Technology Evaluation Center to determine if the technology is eligible for benefit coverage.
Examples of services that HMSA may not cover include those currently in early clinical trials, drugs that aren’t yet approved by the Food and Drug Administration (FDA), and other treatments that lack the evidence that proves the service is safe and effective.