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Medical Policies

We strive to offer our members the latest in proven medical technologies by reviewing current scientific evidence and considering expert physician opinion when we develop our medical policies. We incorporate input from the Massachusetts Medical Society, specialty societies, national technology review organizations and community physicians in the development and review of all policies.

The purpose of our medical policies

The purpose of our medical policies is to provide guidelines for determining coverage criteria for new and evolving medical and behavioral health technologies, including procedures, equipment, and services. 

Medical policy does not override the health insurance contract that defines members’ benefits, nor is it intended to dictate to providers how to practice medicine. Physicians and other health care providers are expected to exercise their medical judgment in providing the most appropriate care.

How you can review and comment on an individual medical policy

Step Go to the BCBSMA medical policy library and search for the policy of interest.
Step Email comments on the policy to our E-Blue Review team at ebr@bcbsma.com. Or, send a fax to 617-246-7084.

Please note: This is not a private email box. Do not send any identifying patient information in your email. The Medical Policy Administration mailbox is only for comments and recommendations of participating ordering providers on medical policies. The Medical Policy Administration mailbox cannot address questions regarding benefits, claims, billing, payment, reimbursement, appeals, individual case exception review, advance determination, prior authorization, or reconsideration review.  

How to take part in a medical specialty-based review of our medical policies 

Each month, BCBSMA's Medical Policy Group meets to review the policies for a specific specialty as listed in the review schedule shown below. The packet of policies for each specialty is available for review and comment beginning in the first week of the month shown.

Review the policies for the current month and email comments to our E-Blue Review team at ebr@bcbsma.com. Or, send a fax to us at 617-246-7084.

Monthly medical policy group meetings

If you are a contracted clinician you may attend and participate in a specialty meetings listed below. All meetings are held from noon to 2 p.m. in conference room 12-I at 101 Huntington Ave, Suite 1300, Boston, MA. A conference call line is also available if you cannot attend in-person. To attend the meeting, either in-person or via conference call, please email ebr@bcbsma.com and we will send you a packet of information.

Specialty policies being reviewed: Meeting Date:
Neurology and Neurosurgery January 31, 2017
Psychiatry, Ophthalmology February 28, 2017
Allergy and ENT/Otolaryngology March 28, 2017
Cardiology and Pulmonary April 25, 2017
Pediatrics and Endocrinology May 30, 2017
Orthopedic, Rehabilitation, and Rheumatology June 27, 2017
Hematology and Oncology July 25, 2017
Urology and Obstetrics/Gynecology September 26, 2017
Gastroenterology, Nutrition and Organ Transplantation October 31, 2017
Plastic Surgery/Dermatology November 28, 2017
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