Live Medical Policies

Our medical policies include evidence-based treatment guidelines. They address common medical situations. You can review our medical policies online any time. Please keep in mind that:

  • The policies aren’t medical advice. They don’t guarantee results or outcomes.
  • These policies may change to stay up to date with current research. A posted policy may not reflect a recent change.
  • We share these policies as information only. The health plan decides how they apply.
  • Just because a service is included in a medical policy doesn’t mean a specific health plan covers it.
  • These policies address situations that occur frequently. Some situations may warrant further individual review.
Durable Medical Equipment (DME)
Medicine (Medical Treatments/Diagnostic Tests)

 

Surgery

 

BlueCross BlueShield of South Carolina is a Medicare Advantage PPO and HMO plan with a Medicare contract. BlueCross Essential, Rx Value and BlueCross Rx Plus are stand-alone prescription drug plans with a Medicare contract. Enrollment in BlueCross Total, BlueCross Total Value, BlueCross Blue Basic, BlueCross Secure, BlueCross Essential, BlueCross Rx Value or BlueCross Rx Plus depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year.

Out-of-network/non-contracted providers are under no obligation to treat BlueCross BlueShield of South Carolina Medicare members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call Customer Service or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

BlueCross BlueShield of South Carolina does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status in our health plans, when we enroll members or provide benefits. Free language interpretation services are available for those who cannot read or speak English. Read our Non-Discrimination Statement and Foreign Language Access policy.