By clicking on the "I accept" button below, I acknowledge that I understand and accept the following:

These policies guide Employer Provider Network, Inc. (EPNI) in making medical necessity determinations and are technical in nature. These policies are designed for reference purposes only. These policies are used for making medical necessity determinations for persons with a specific condition. They should not be construed as medical advice.

EPNI will consider each individual's condition and unique circumstances in making determinations and will make each determination on a case-by-case basis and according to the terms of the individual's coverage. EPNI reserves the right to revise, update and/or add to these policies at any time without notice. If individuals or providers have questions about a policy, they are welcome to contact EPNI.

A list of services for which prior authorization is recommended is provided. The fact that a particular service is not included on this list does not mean that such service is otherwise covered. Receipt of benefits is subject to all terms and conditions of an individual's plan documents. Individuals and providers should consult their plan documents to review the provisions relating to a specific coverage determination, including exclusions and limitations.

These guidelines in no way imply that individuals should not receive specific services based on the recommendation of the provider. These guidelines govern medical necessity and not clinical practices. Providers are responsible for medical advice and treatment of patients. Individuals with specific health care needs should consult an appropriate health care professional.

Individuals and providers have rights to appeal medical necessity determinations. These rights are spelled out in plan documents. Questions about appeal rights should be directed to health plan customer service or provider service.