BCN medical review standards
Our Medical Review staff works closely with your doctor to make sure you get good medical care according to standard medical practice and your health benefits package.
Decisions about a member’s care are based solely on the appropriateness of care prescribed in relation to the member’s specific medical condition. Our clinical reviewers do not have financial arrangements that encourage denial of coverage or service. Nurses and physicians employed by Blue Care Network do not receive bonuses or incentives based on their review decisions. Medical review decisions are based strictly on medical necessity and providing high-quality care for members within the limits of their coverage.
page modified 04/23/2008