Experimental or investigational services definition

Experimental or investigational services means health care items or services that are:

Experimental or investigational services means services, supplies, care and treatment which does not constitute accepted medical practice properly within the range of appropriate medical practice under the standards of the case and by the standards of a reasonably substantial, qualified, responsible, relevant segment of the medical and dental community or government oversight agencies at the time services were rendered. The Plan Administrator must make an independent evaluation of the experimental/nonexperimental standings of specific technologies. The Plan Administrator shall be guided by a reasonable interpretation of Plan provisions and may employ the services of such medical peer review service organizations as the Medical Review Institute or UMAC and utilize data obtained from such national assessment organizations as HCFA, the Office of Health Technology Assessment and Institutes of the Department of Health and Human Services to aid in its determination. The decisions shall be made in good faith and rendered following a detailed factual investigation of the claim and the proposed treatment. The decision of the Plan Administrator will be final and binding on the Plan. The Plan Administrator will be guided by the following principles:

Examples of Experimental or investigational services in a sentence

• Experimental or investigational services and related exams or consultations.

• Experimental or investigational services or supplies as defined on page 74.

• Experimental or investigational services, including any treatment, therapy, procedure or drug or drug usage, facility or facility usage, equipment or equipment usage, device or device usage, or supply which is not recognized as being in accordance with generally accepted professional standards or for which the safety and efficacy have not been determined for use in the treatment for which the item or service in question is recommended or prescribed.

• Previously, benefits were available for lobar lung transplants performed at these types of facilities.• We revised our definition of Experimental or investigational services.

• Experimental or investigational services, procedures, or supplies which are not usual standard of care.

• Experimental or investigational services: MAD does not cover procedures, technologies or therapies that are considered experimental or investigationalR.

• Experimental or investigational services other than services provided through the Independent Medical Re- view process.2. Services not Medically Necessary as determined by Landmark3.

• Finally, students interpret oral and written messages as they listen to native speakers describe past experiences as volunteers and read short cultural notes, advertisements, and course descriptions.Culture The premise of Pasaporte is to pique students’ curiosity about opportuni- ties to travel, work, and study abroad.

• Extractions, dental caries, periodontics (including but not limited to gingivitis, periodontitis and periodontosis) or the correction of impactions will not be covered.• Services or supplies for the administration of anesthesia if the charges for surgery are not covered under the EMHP.• Services or supplies to the extent they are not covered by the hospital portion because you failed to follow Program Requirements.• Experimental or investigational services or supplies.

• Experimental or investigational services, supplies, or drugs, except for clinical trials consistent with Medicare coverage criteria.