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Call: 1-800-892-3351.
TTY/TDD should call
1-800-216-1307.
Hours of operation are: 8 a.m. to 8 p.m. local time, Monday through Friday.

Medical Policy Terms and Conditions

By clicking on “Accept” below, I acknowledge receipt of the following information:

These policies were written to guide HealthMarkets Care Assured in making coverage determinations and are technical in nature. They are designed to be for reference purposes only and do not guarantee coverage. These policies are used for making coverage determinations for persons with a specific condition. They should not be construed as medical advice. HealthMarkets Care Assured will consider each enrollee’s condition, unique circumstances and the terms of the enrollee’s contract when making coverage determinations. HealthMarkets Care Assured reserves the right to revise, update and/or add to these policies at any time without notice. If enrollees or providers have questions about a policy, they should feel free to contact HealthMarkets Care Assured.

Receipt of benefits is subject to all of the terms and conditions of the enrollee’s Evidence of Coverage. Enrollees should refer to their Evidence of Coverage to review the provisions relating to a specific coverage determination, including exclusions and limitations. Providers should understand their rights and responsibilities under their contract. If there is a conflict between these policies and the contract or plan documents, the contract or plan documents shall govern.

These guidelines in no way imply that enrollees should not receive specific services based on the recommendation of the provider. Providers are responsible for medical advice and treatment of patients. Enrollees with specific health care needs should consult the appropriate health care professional.

This information is not an offer of coverage, solicitation of coverage, summary of benefits or guarantee of coverage. All products and coverage guidelines are subject to applicable laws and regulations. Reimbursement or coverage is subject to all of the applicable terms, conditions, limitations and exclusions of the enrollee’s Evidence of Coverage or to the terms and conditions of the applicable provider agreement.

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