Medical Policies were developed to assist WPS in making coverage decisions. Medical policies are provided here for informational purposes. The policies do not constitute medical advice or medical care. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. WPS Members should discuss the information in the medical policies with their treating health care professionals.
Benefit plans vary in coverage and some plans may not provide coverage for certain services listed in these policies. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. Medical policy does not constitute plan authorization, an explanation of benefits, or a guarantee of payment. Because medical technology is constantly changing, these medical policies are periodically reviewed and subject to change without notice. WPS is not responsible for the continuing viability of the website addresses listed in policy references. Additional medical policies may be developed from time to time and some may be withdrawn from use.
Some benefit plans administered by WPS, such as some self-funded employer plans or governmental plans, may not utilize WPS medical policy in their coverage determinations. Members should contact their local customer services representative for specific plan, benefit, and network status information.
The doctors, hospitals, and other providers which are part of the plan network are independent contractors who exercise independent judgment and over whom WPS has no control or right of control. They are not agents or employees of WPS.
This disclaimer applies to all present and past Medical Policies.