Experimental or Investigative definition

Experimental or Investigative means treatments, devices or prescription medications which are recommended by a Physician, but are not considered by the medical community as a whole to be safe and effective for the condition for which the treatments, devices or prescription medications are being used. This includes any treatments, procedures, facilities, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice, and any of those items requiring federal or other governmental agency approval not received at the time services are rendered.

Experimental or Investigative means a drug, device, medical treatment or procedure that:

Experimental or Investigative means treatment, a device or prescription medication which is recommended by a Physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device or prescription medication is being used. This includes any treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice, and any of those items requiring federal or other governmental agency approval not received at the time services are rendered. “Family Member” means the Insured’s, or Traveling Companion’s spouse, Domestic Partner, Child, daughter-in- law, son-in-law, brother, sister, mother, father, grandparents, grandchild, step-child, step-brother, step-sister, step-parents, parents-in-law, brother-in-law, sister-in-law, aunt, uncle, niece, nephew, legal guardian, Caregiver, foster Child, ward,

Examples of Experimental or Investigative in a sentence

• If an Insured Person has an Adverse Determination based on an Experimental or Investigative Treatment, the provision entitled External Review of Denial of Experimental or Investigative Treatment will apply.

• External Review of Denial of Experimental or Investigative Treatment Within sixty (60) days after the date of receipt of a notice of an Adverse Determination or final Adverse Determination that involves a denial of coverage based on a determination that the health care service or Treatment recommended or requested is Experimental or Investigational, an Insured Person or the Insured Person's authorized representative may file a request for external review with the Commissioner of Insurance.

• APPEALS PROCEDURE 35Internal Review Procedure 35External Review Procedure 37External Review of Denial of Experimental or Investigative Treatment 38 INSURANCE INFORMATION SCHEDULE POLICYHOLDER: William Penn University POLICY NUMBER: AIIC1718IASHIP49Oskaloosa, Iowa EFFECTIVE DATE: August 01, 2017 TERMINATION DATE: August 01, 2018 The Policy Year runs from the Policy Effective date until the Policy Termination Date.

• Certain Treatments and medications, such as vitamins, herbs, aspirin, cold remedies, medicines, Experimental or Investigative drugs, or medical Supplies even when recommended by a Physician, do not qualify as Prescription Drugs.

• Services or supplies that the Insurer considers to be Experimental or Investigative.

More Definitions of Experimental or Investigative

Experimental or Investigative means treatment, a device or prescription medication which is recommended by a Physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device

Experimental or Investigative means any treatments, procedures, facilities, equipment, drugs, drug usage, devices, or supplies:

Experimental or Investigative means not approved or broadly accepted and recognized by the Canadian medical profession as an effective, appropriate and essential Medical Treatment of a Sickness or Injury, in accordance with Canadian medical standards.

Experimental or Investigative means treatment, a device or prescription medication which is recommended by a Physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device or prescription medication is being used, including any treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not rec- ognized as accepted medical practice, and any of those items requiring federal or other governmental agency approval not received at the time services are rendered. “Hospital” means a place that: (a) holds a valid license; (b) is run mainly for the care and treatment of sick or injured persons as inpatients; (c) has a staff of one or more Physicians available at all times; (d) provides 24-hour nurs- ing service and has at least one registered nurse on duty at all times; (e) has organized diagnostic and surgical facili-

Experimental or Investigative means in connection with a drug, device, treatment, or procedure that:

Experimental or Investigative means in connection with a drug, device, treatment or procedure that:▪ with respect to the illness being treated, the drug, device, treatment, or procedure cannot be lawfully marketed in the U.S. or has not been approved by the U.S. Food and Drug Administration (FDA) at the time the drug or device is furnished; or▪ with respect to the illness being treated, the drug, device, treatment or procedure, or the patient informed consent document used with the drug, device, treatment or procedure, requires reviewand approval by the treating facility’s Institutional Review Board or other body serving a similar function, or if U.S. federal law requires such review and approval; or‌‌▪ with respect to the illness being treated, reliable evidence shows that the prevailing opinion among experts in the appropriate field regarding the drug, device, medical treatment or procedure is that further studies or clinical trials are necessary to determine its maximum tolerated dose, toxicity, safety, efficacy or its efficacy as compared with a standard means of treatment or diagnosis.▪ Reliable evidence means only published reports and articles in medical and scientific literature including the opinions of the FDA, Council of Medical Specialty Services (CMSS), National Institute of Health (NIH) and Mental Health (NIMH), Office of Health Technology Assessment (OHTA), American Medical Association (AMA), American Dental Association (ADA) or Clinical Efficacy Assessment Program (CEAP); the written protocol(s) used by the treating facility or another facility studying substantially the same drug, device, medical treatment or procedure; or the written informed consent used by the treating facility or by another facility studying substantially the same drug, device, medical treatment or procedure.

Experimental or Investigative means treatment, a device or prescription medication which is recommended by a Physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device or prescription medication is being used. This includes any treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not