WPS Health Insurance

Medical and Pharmacy Policies

WPS' Medical Policies have been developed to assist in making coverage determinations under WPS health policies or plans. If you are looking for the Medical Policy guidelines for a patient covered by Medicare go to the WPS Medicare website.

Policies are for informational purposes only and are not Practice Guidelines or medical advice. Policies are adopted after careful review of published and peer-reviewed scientific literature, evidence based guidelines from national professional organizations, and local standards of practice in diagnosis and treatment. Medical Policies are approved by the WPS Policy Committee. Medical policies are based on constantly changing medical science and are periodically reviewed and updated. WPS recommends providers review this site periodically for changes.

Coverage determinations are subject to all terms and conditions of the member's plan, including specific exclusions and limitations, and to applicable federal and state law. Eligibility and benefits are determined by the plan contract that is in effect at the time that a service is provided to the member. Members are encouraged to review the Medical Policies with their health care providers to insure mutual understanding.

Members and their providers will need to consult the member's benefit plan to determine if there is any exclusion or other benefit limitations applicable to the service or supply. The member's benefit plan ultimately determines coverage.

WPS welcomes your feedback regarding research and development of criteria in the Medical Policies. Comments regarding specific criteria should include supporting references from peer-reviewed high level scientific literature. Please respond to medical.policies@wpsic.com.

For questions regarding a member's specific benefits, please contact Member / Customer Services as identified on the member's insurance card.

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