Medical Necessity Examples. Examples of hospitalization and other Health Care Services that are not Medically Necessary include:
Medical Necessity Examples Sample Clauses
Related to Medical Necessity Examples
Medical Necessity We Cover benefits described in this Contract as long as the dental service, procedure, treatment, test, device, or supply (collectively, “service”) is Medically Necessary e.g. orthodontia. The fact that a Provider has furnished, prescribed, ordered, recommended, or approved the service does not make it Medically Necessary or mean that We have to Cover it. We may base Our decision on a review of: • Your dental records; • Our dental policies and clinical guidelines; • Dental opinions of a professional society, peer review committee or other groups of Physicians; • Reports in peer-reviewed dental literature; • Reports and guidelines published by nationally-recognized health care organizations that include supporting scientific data; • Professional standards of safety and effectiveness, which are generally-recognized in the United States for diagnosis, care, or treatment; • The opinion of health care professionals in the generally-recognized health specialty involved; • The opinion of the attending Providers, which have credence but do not overrule contrary opinions. Services will be deemed Medically Necessary only if: • They are clinically appropriate in terms of type, frequency, extent, site, and duration, and considered effective for Your illness, injury, or disease; • They are required for the direct care and treatment or management of that condition; • Your condition would be adversely affected if the services were not provided; • They are provided in accordance with generally-accepted standards of dental practice; • They are not primarily for the convenience of You, Your family, or Your Provider; • They are not more costly than an alternative service or sequence of services, that is at least as likely to produce equivalent therapeutic or diagnostic results; • When setting or place of service is part of the review, services that can be safely provided to You in a lower cost setting will not be Medically Necessary if they are performed in a higher cost setting. See the Utilization Review and External Appeal sections of this Contract for Your right to an internal Appeal and external appeal of Our determination that a service is not Medically Necessary.
Corrective Measures If the Participating Generator fails to meet or maintain the requirements set forth in this Agreement and/or the CAISO Tariff, the CAISO shall be permitted to take any of the measures, contained or referenced in the CAISO Tariff, which the CAISO deems to be necessary to correct the situation.
Medically Necessary In general, We will not Cover any dental service, procedure, treatment, test or device that We determine is not Medically Necessary. If an External Appeal Agent certified by the State overturns Our denial, however, We will Cover the service, procedure, treatment, test or device for which coverage has been denied, to the extent that such service, procedure, treatment, test or device, is otherwise Covered under the terms of this Contract.
Volunteer Firefighting Leave Leave without pay will be granted when an employee who is a volunteer firefighter is called to duty to respond to a fire, natural disaster or medical emergency.
Personal Necessity 1.9.1 Unit members may use up to a maximum of ten (10) sick leave days from their current year sick leave allocation each work year for purposes of personal necessity.
Catastrophic Leave Program Leave credits, as defined below, may be transferred from one or more employees to another employee, on an hour-for-hour basis, in accordance with departmental policies upon the request of both the receiving employee and the transferring employee and upon approval of the employee's appointing authority, under the following conditions:
Stewardship The efficient and effective management of the public funds that have been entrusted to the FHWA.
Medical Examinations An employee may be required by the Employer, at the request of and at the expense of the Employer, to take a medical examination by a physician of the employee's choice. Employees may be required to take skin tests, x-ray examination, vaccination, inoculation and other immunization (with the exception of a rubella vaccination when the employee is of the opinion that a pregnancy is possible), unless the employee's physician has advised in writing that such a procedure may have an adverse affect on the employee's health.
CULTURAL DIVERSITY The Cultural Diversity Requirement generally does not add units to a student's program. Rather, it is intended to be fulfilled by choosing courses from the approved list that also satisfy requirements in other areas of the student’s program; the exception is that Cultural Diversity courses may not satisfy Culture and Language Requirements for B.S. students. For example, Ethnic Studies 134 can fulfill (3) units of the Behavioral Science requirement and (3) units of the Cultural Diversity requirement. This double counting of a class may only be done with the Cultural Diversity requirement. Courses in Cultural Diversity may be taken at the lower-division or upper-division level. U . S . H I S T O R Y I N S T I T U T I O N A L R E Q U I R E M E N T HIS 100, 201
Protective Measures We have implemented and will maintain appropriate technical and organisational measures in relation to the Services taking into account the state of the art, the costs of implementation, and the nature, scope, context and purposes of Processing, as well as the likelihood and severity of risk to the rights and freedoms of data subjects. This includes measures relating to the physical security of Our facilities used to deliver them, measures to control access rights to Our assets and relevant networks, and processes for testing these measures. In accordance with Our obligations under applicable law, We may undertake digital forensic investigations in relation to the use of the Services and Subscriptions. You are responsible for using, and ensuring that your Users use, the controls and advice provided by the Services correctly and consistently.
