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Coverage criteria and guidelines

The information presented regarding coverage criteria and guidelines is regularly updated and is subject to change without notice. CoOportunity Health reserves the right to publish additional and revised coverage guidelines without specific notice to members or providers.

Consult your policy documents (policy/certificate and benefits chart) to determine governing contractual provisions, including exclusions and limitations relating to your specific health plan. Please contact Member Services if you have any questions. In the event of a conflict between your specific policy documents and these general guidelines, your policy documents will govern.

These coverage criteria and guidelines are not medical advice. The guidelines are technical and written to assist medical personnel in making coverage determinations. You should receive specific services based on the recommendation of your provider. Your providers are responsible for medical advice and treatment. If you have specific health care needs, you should consult with a health care professional.

You do have rights to appeal certain coverage determinations. These appeal rights are explained in your policy documents. If you have questions regarding appeal rights, please contact Member Services.

The information contained in the coverage criteria and guidelines are not an offer of coverage, solicitation of coverage, summary of coverage or guarantee of coverage. All products and coverage guidelines are subject to applicable federal and state law. Your coverage is governed by all applicable terms, conditions, limitation and exclusions in your policy documents.