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Review Medical Policies

The policies below summarize Well Sense Health Plan's criteria for covering specific services. The plan uses policies as a guide to make determinations regarding healthcare coverage and payment. To ensure you are viewing the most recent version of the policy, you may want to clear your browser's cache.

Please note that the member must be eligible for services before medical coverage policies are applied to any claim. As a result, Well Sense Health Plan can not guarantee payment when a member is ineligible or a non-covered benefit is rendered. Review pharmacy policies here.

Search Medical Policies

Type	Title	Language
	Actigraphy Testing (Policy OCA 3.712), Effective 12/01/21	Medical Policies
	Acupuncture (Policy OCA 3.17), Effective 01/01/22	Medical Policies
	Adult Medical Day Care (Policy OCA 3.716), Effective 05/01/22	Medical Policies
	Adult Medical Day Care (Policy OCA 3.716), Effective 12/01/21 and Retired 04/30/22	Medical Policies
	Ambulance and Transportation Services (Policy OCA 3.191), Effective 12/01/21 And Retired 04/30/22	Medical Policies
	Ambulatory Cardiac Monitors (Excluding Holter Monitors) (Policy OCA 3.35), Effective 01/01/22	Medical Policies
	Autism Spectrum Disorders Medical Diagnosis and Treatment (Policy OCA 3.724), Effective 12/01/21	Medical Policies
	Balloon Sinus Ostial Dilation (Policy OCA 3.706), Effective 12/01/21	Medical Policies
	Biofeedback in an Outpatient Setting to Treat Incontinence or Constipation (Policy OCA 3.969), Effective 01/01/22	Medical Policies
	Breast Reconstruction (Policy OCA 3.43), Effective 05/01/22	Medical Policies
	Breast Reconstruction (Policy OCA 3.43), Effective 12/01/21 And Retired 04/30/22	Medical Policies
	Breast Reduction Surgery (Policy OCA 3.44), Effective 05/01/22	Medical Policies
	Breast Reduction Surgery (Policy OCA 3.44), Effective 12/01/21 And Retired 04/30/22	Medical Policies
	CAR T-Cell Therapy to Treat Hematological Malignancies (Policy OCA 3.22), Effective 01/01/22	Medical Policies
	Cardiac Rehabilitation, Outpatient (Policy OCA 3.61), Effective 11/01/21 Used in Conjunction with InterQual Criteria	Medical Policies

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