Aspirus Health Plan Coverage Policies Disclaimer
Coverage Policies are developed to assist in identifying coverage for Aspirus benefits under Aspirus’s health plans. They are intended to serve only as a general reference regarding Aspirus’s administration of health benefits and are not intended to address all issues related to coverage for health services provided to Aspirus members.
These services may or may not be covered by all Aspirus products (refer to product section of individual coverage policy for product-specific detail). Providers are encouraged to have their Aspirus patient refer to their Aspirus plan documents (Evidence of Coverage/Member Handbook/Member Contract) for specific coverage information. If there is a conflict between a coverage policy and the Aspirus plan documents, the Aspirus plan documents prevail.
Medicare products may provide different coverage for certain services, which may be addressed in different policies. For Medicare National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and/or Local Coverage Articles, please consult CMS, National Government Services, or CGS websites.
Coverage Policies do not constitute medical advice. Providers are responsible for submission of accurate and compliant claims.
How Coverage Policies Are Developed
Aspirus Coverage Policies are developed based on the applicable Aspirus plan documents, and available regulatory guidance. Aspirus Coverage Policies further define benefits in the applicable plan documents. Note that coverage policies do not exist for every benefit section of the relevant plan document.
Aspirus Coverage Policies are reviewed annually and updated as needed.
Coverage policies are subject to change.
How Coverage Policies Are Used
When making coverage decisions, Aspirus staff apply the benefits associated with the member’s enrollment and eligibility, according to federal and state regulations, and the member’s specific plan document (Evidence of Coverage/Member Handbook/Member Contract). Aspirus Staff reference Coverage Policies, when available, in addition to the Aspirus member’s specific plan document. Aspirus’s Coverage Policies help to clarify a section of the Aspirus member’s plan document.