Medical Policies (Medical Coverage Guidelines)
Florida Health Care Plans (FHCP), an affiliate of Blue Cross Blue Shield of Florida, strives to cover procedures, treatments, devices and drugs proven to be safe and effective for a particular disease or condition. We also continually look at new medical advances and technology for consideration of FHCP coverage and payment purposes to determine if any is superior to those already in use. To aid in the decision-making for the development of these Medical Policies (Medical Coverage Guidelines), we consult expert sources, such as the views of physicians practicing in the relevant clinical area, review of clinical studies published in respected scientific journals and the opinions from various specialty medical organizations. We provide our Medical Policies (Medical Coverage Guidelines) to our members, physicians and providers so that all are apprised of the criteria used in determining coverage for payment purposes.
Medical Policies
FHCP is licensed to use Milliman Care Guidelines® to guide utilization management decisions. Please click here for more information about how FHCP uses this tool.
Pharmacy Guidelines
Click here to view drugs that indicate "Prior Auth Required" in the FHCP formulary.
Request for Review
New information or technology that would be relevant to FHCP to consider when these policies are next reviewed may be submitted to:
Florida Health Care Plans
Clinical Services Division
1340 Ridgewood Avenue
Holly Hill, Florida 32117
1 800 352 9824 option 9
Please have your patient refer to the applicable endorsement or rider issued with his or her contract, Evidence of
Coverage, member handbook or certificate of coverage to determine coverage. If your patient is unsure about
particular coverage/benefits or has questions, please have the member call the Member Services number on his or
her ID card.
