Evaluating the Use of New Technology

Sometimes your provider may ask us to cover a treatment or service that requires new technology. Here are some criteria we consider when adding technology to coverage!

We often look at new technologies to potentially include as a covered service. We will consider coverage when all the following criteria are met:

1. The technology must be nonexperimental and noninvestigational.
2. The new technology must be approved by the appropriate regulatory body.
3. Research and review of evidence-based medicine must demonstrate that new technology has a positive effect on health and is safe.
4. The new technology must be more beneficial or less expensive than current alternative treatments.

If your provider asks us to cover a treatment or service that requires new technology, we will make a coverage decision within five business days after receiving all the information needed to complete our evaluation. If coverage is denied, we will communicate the reason for the denial to your provider, as well as an explanation of our grievance process.