Medically Appropriate Sample Clauses
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Medically Appropriate. The term “Medically Appropriate” means services and medical supplies which are required for prevention, diagnosis, or treatment of sickness or injury, and which are:
1.18.1 Consistent with the symptoms of a medical condition or treatment of a medical condition;
1.18.2 Appropriate with regard to standards of good medical practice and generally recognized by the medical scientific community as effective;
1.18.3 Not solely for the convenience of the Member or provider of the service or medical supplies; and
1.18.4 The most cost effective of the alternative levels of service or medical supplies which can be safely provided to the Member in HPSM’s judgment.
Medically Appropriate. “Medically Appropriate” means health services, items, or medical supplies that are:
Medically Appropriate. Health Care Services that are Medically Necessary and that are determined in accordance with applicable laws, rules, regulations and professional standards to be (1) consistent with the symptoms of a health condition or treatment of a health condition, illness, or injury; (2) appropriate with regard to the most current standard of practice for the safe and effective assessment, treatment, or management of the applicable health condition, illness, or injury as determined by the relevant scientific community and professional bodies; (3) not solely for convenience of a Enrollee or the Health Care Professional providing the Health Care Services; and (4) more cost-effective than alternative services or supplies that could be employed for the safe and effective assessment, treatment, or management of the applicable health condition, illness, or injury under prevailing standards of scientific knowledge and clinical practice among practitioners with like credentials providing Health Care Services in the State.
Medically Appropriate. Medically Appropriate" means Medical Services which, under provisions of this Agreement, are determined to be: (i) appropriate for the prevention, diagnosis or treatment of the symptoms, injury or disease; (ii) provided for the prevention, diagnosis or direct care and treatment of the symptoms, injury or disease; (iii) within medical, dental or other health care practice standards within the health care community; (iv) not primarily for the convenience of Hospital, Eligible Subscriber or Participating Provider providing Covered Services to Eligible Subscriber; and (v) an appropriate level of service or supply needed to provide safe and adequate care.