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Vermont Medical Policies
These documents are provided for informational purposes only and are not an authorization, certification, explanation of benefits or a contract. Benefits and eligibility are determined before medical guidelines and payment guidelines are applied. Benefits are determined by the subscriber certificate that is in effect at the time services are rendered. Medical practices and knowledge are constantly changing and we reserve the right to review and revise medical policies periodically and without notice.
When available, we may utilize BCBSVT approved medical policies or those specific to plans as outlined below. When an appropriate policy does not exist we may utilize the medical policies of the national Blue Cross & Blue Shield Association as guidance to determine medical necessity. These policies are available on request by providers.
University of Vermont Medical Center (formerly Fletcher Allen Health Care) Members (alpha prefixes FAH, FAC or FAO):
To view medical policies for dates of service through December 31, 2013, click here.
For dates of service beginning January 1, 2014, please refer to the University of Vermont Medical Center section first. If the service is not listed there, refer to the general 'Vermont Medical Policies' listed on this page.
University of Vermont Medical Center (formerly Fletcher Allen Health Care) Medical Policies_
These medical policies only apply to University of Vermont Medical Center members, alpha prefixes FAH, FAC or FAO.
Note: These policies are currently under review. Once approved the policy will be posted.
- Compression Stockings
- Continuous Glucose Monitoring
- Home INR
- Infertility Benefits
- Outpatient Cardiac Rehabilitation
Archived Medical Policies
BCBSVT archived medical policies are inactive; once archived, policies are no longer updated. Archived policies will remain available for a period of one year.
Policies may be archived because:
- the technology is obsolete or discarded
- the technology has become standard of care and details about its use are well known
- BCBSVT is no longer implementing the policy
The information in the archived policies is current through the last review date before the policy was archived. These policies may be useful for providing background information or for understanding benefit determinations made when the policy was active. However, because archived policies are not updated, providers should not rely on them as a source of information with respect to current requests for coverage.