Medically Necessary definition

Medically Necessary means a service which is appropriate and consistent with the treatment of the condition in accordance with accepted standards of community practice.

Medically Necessary means that a treatment, service, or supply:

Medically Necessary means the need to have medical service for the purpose of investigating or treating the relevant Disability in accordance with the generally accepted standards of medical practice and such medical service must –

Examples of Medically Necessary in a sentence

• Any contractual provisions, including gag clauses or rules, that restrict a Provider's ability to advise Members about Medically Necessary treatment options violate federal law and regulations.

• Provider understands and agrees that each claim Provider submits to Subcontractor or CCO constitutes a certification that the claim is true and accurate to the best of Provider’s knowledge and belief and that the Covered Services are 1) Medically Necessary and 2) have been provided to the Member prior to submitting the claim.

• Members are entitled to the full range of their Providers' opinions and counsel about the availability of Medically Necessary Services under the provisions of the MississippiCHIP Program Contract.

• Neither Subcontractor nor CCO shall structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Member.

• Subcontractor, CCO and Provider may not make a specific payment directly or indirectly under a PIP to a physician or physician group as an inducement to reduce or limit Medically Necessary services furnished to an individual Member.

More Definitions of Medically Necessary

Medically Necessary means services or supplies that, under the provisions of this Contract, are determined to be:

Medically Necessary means a treatment, service, or supply that is: 1) required to treat an Injury or Sickness; 2) prescribed or ordered by a Doctor or furnished by a Hospital; 3) performed in the least costly setting required by the Covered Person’s condition; and 4) consistent with the medical and surgical practices prevailing in the area for treatment of the condition at the time rendered. Purchasing or renting 1) air conditioners; 2) air purifiers; 3) motorized transportation equipment; 4) escalators or elevators in private homes; 5) eyeglass frames or lenses; 6) hearing aids; 7) swimming pools or supplies for them; and 8) general exercise equipment are not Medically Necessary. A service or supply may not be Medically Necessary if a less intensive or more appropriate diagnostic or treatment alternative could have been used. We may consider the cost of the alternative to be the Covered Expense.

Medically Necessary means a service or supply which: (a) is recommended by the attending Legally Qualified Physician: (b) is appropriate and consistent with the diagnosis in accord with accepted standards of community practice: (c) could not have been omitted without adversely affecting an Insured’s condition or quality of medical care: (d) is delivered at the most appropriate level of care and not primarily for the sake of convenience: and (e) is not considered experimental unless coverage for experimental services or supplies is required by law.

Medically Necessary means there must be a medical need for the leave and that the leave can best be accomplished through an intermittent or reduced leave schedule.

Medically Necessary means services, tests, medicines or supplies rendered, supervised or ordered by a hospital, skilled nursing facility, doctor or other provider required to treat an illness or injury and customarily recognized within the medical profession as appropriate in the care and treatment of the diagnosed condition in the opinion of the Fund, subject to the Claims Review and Appeal procedures of this SPD.

Medically Necessary means any treatment, tests, medication, or stay in Hospital or part of a stay in Hospital which: i. is required for the medical management of the Illness or Injury suffered by the Scheme Member; ii. must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration, or intensity; iii. must have been prescribed by a Medical Practitioner; iv. must conform to the professional standards widely accepted in international medical practice or by the medical community in India.

Medically Necessary means a medical service which is:-