Medical Policy Disclaimer

The Medical Policies you are about to view are the property of Blue Cross Blue Shield of Nebraska (BCBSN). They have been developed by the BCBSN Medical Policy Committee (Committee) for use by BCBSN in determining the scientific validity of new and existing medical technologies, treatments, devices, drugs, etc. In developing these evidence-based Medical Policies, the Committee consults with medical experts and reviews scientific publications, including, but not limited to, Blue Cross Blue Shield Association Technology Evaluation Center (TEC) and peer-reviewed journals and periodicals. The Medical Policies are used in administering plan benefits and do not constitute medical advice. Physicians and other health care providers are responsible for providing medical advice and treatment. The Committee reviews new technologies as they emerge as well as existing Policies on a regular basis; therefore, these Policies are subject to change without notice. These Medical Policies do not constitute authorization, certification or a contract for benefits. Benefits for a particular service or item are determined by the terms and conditions of the applicable benefit contract.

These policies reference CPT codes. Current Procedural Terminology (CPT) is copyright 2011 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

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The percentage of the bill you pay after your deductible has been met.


A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 


The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.


Includes behavioral health treatment, counseling, and psychotherapy

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)


Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.


If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.


The amount you pay to your health insurance company each month. 

Preventive services

Health care services that focus on the prevention of disease and health maintenance.


Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).


A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.