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Medical Policies

Medical Policies​​

Following, we include the Medical Policies approved by MCS Healthcare Holdings, LLC. (MCS). These have been developed to ease the administration process of the benefits in terms of coverage and medical ​needs. Medical Policies are subject to the determinations included in the insured member’s coverage.

MCS can define policies for processes, diagnostic tests, images, DME, drug usage and other services. These are based on scientific literature, and criteria developed by specialized groups, and guides adopted by health care organizations like Medicare, among others.

Services classified as new technologies, are also evaluated to define or set the limits of the coverage. The criteria used to evaluate new technologies include:

  • Final approval from the concerning government regulation agencies (excluding “Humanitarian Device Exception”, issued by the FDA)
  • Scientific evidence that enables conclusions concerning the effect of this technology on the health of the insured member.
  • General comparison of the new technology to other existent technologies used for the same purposes.

Medical technology reemerges constantly. For such reason, policies are subject to changes without prior notice, with the exception of those required by Law. Medical Policies can be developed and revised as necessary. If any supplier requires any revision of the established policies, a written application must be submitted to:

Att: Medical Politics Clinic Manager

Medical Policy Department/ Medical Affairs Division Médicos

MCS Healthcare Holdings, LLC.

PO Box 902347

San Juan PR 00902-3547

The provider should submit the specific issue to be reviewed or discussed, and include clinical evidence, references and/or the approval of the corresponding agency, if applicable.