We regularly review the latest procedures, drugs, devices, and methods to determine which will improve medical outcomes. The task of determining when the new is appropriate and the old is no longer acceptable is complex – it involves a lot of research, reviewing members’ claims, and taking part in many other processes to determine when new treatments are appropriate for members.
The Technology Evaluation Center (TEC), a program of the Blue Cross and Blue Shield Association, is a valuable tool used to evaluate new technology. TEC provides scientific analysis and opinions that advance the understanding of complex technology issues. Wellmark uses a criteria established by TEC in the development of medical policy:
- The technology must have final approval from the appropriate government regulatory bodies. All new devices and technologies, with the exception of new procedures, require approval from the Food and Drug Administration.
- The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes.
- The technology must improve the net health outcome.
- The technology must be as beneficial as any established alternatives.
- The improvement must be attainable outside the investigational settings.
If you or your physician need more information regarding whether Wellmark covers a new technology or if you would like to submit a request to have new technology reviewed, call the Customer Service number on your Wellmark ID card.