Experimental Technologies

This policy governs coverage determinations for experimental, investigational, or potentially experimental/investigational medical and behavioral health technologies (drugs, procedures, devices, services, or supplies) when no other specific policy applies. Coverage is decided case‑by‑case—generally for members with severe conditions who have exhausted established treatments or have no alternatives—and requires well‑designed evidence of clinical benefit, informed consent, applicable regulatory approval and consistency with the member’s benefit plan and state/federal rules; technologies lacking quality evidence, still investigational, or only beneficial in research settings are not covered.

"Provides general guidelines to determine coverage of experimental, investigational, or potentially experimental/investigational medical and behavioral health technologies (drugs, procedures, device..."