I AM: A Doctor / Provider
Health Plan of Nevada and Sierra Health and Life (the health plan) develop medical protocols based on comprehensive review of scientific literature regarding safety and efficacy of certain services, with input from local practitioners and/or national experts. Medical Directors actively participate in this process and approve all medical protocols. Medical protocols are reviewed annually and as needed and revised according to changes in technology and scientific evidence.
Medical protocols serve as one of the sets of guidelines for coverage decisions. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical protocols. 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 protocols do not constitute plan authorization or offers of coverage, nor are they an explanation of benefits.
Medical protocols can be technically complex and are provided here for informational purposes. Medical protocols contain only a partial, general description of plan or program benefits and does not constitute a contract. The medical protocols do not constitute medical advice or care. The health plan does not provide health care services and, therefore, cannot guarantee any results or outcomes. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. Health plan members should discuss the information in the medical protocols with their treating health care provider.
Due to the nature of medical technology these protocols are updated and, therefore, subject to change without notice. Additional medical protocols may be developed from time to time and some may be discontinued. The health plan members should contact member services for specific coverage information.