Locally underwritten Blue Cross and Blue Shield of Kansas (BCBSKS) member contracts include a general exclusion for any drug, device or medical treatment or procedure and related services that are experimental or investigational. (The definition of experimental or investigational as defined in the member contract appears below - view definition.)
The BCBSKS provider contract prohibits the provider from billing a member for experimental or investigational services unless the provider issued a written notice in advance stating that a specific service was not covered and why.
Providers are responsible to know if services offered at their facility are experimental or investigational. While it is not the responsibility of BCBSKS to keep providers informed of medical protocols and approvals, we may become aware of information about services through communications with providers and other medical resources.
This notice includes a list of experimental or investigational services. The list:
The following definition appears in the locally underwritten BCBSKS member contract.
Experimental or Investigational refers to the status of a drug, device, medical treatment or procedure:
Credible Evidence means only published reports and articles in the authoritative medical and scientific literature; the written protocol or protocols used by the treating eligible provider or the protocol of another eligible provider providing or studying substantially the same drug, device, medical treatment or procedure; or the written informed consent used by the treating eligible provider or by another eligible provider providing or studying substantially the same drug, device, medical treatment or procedure.
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