MEDICALLY NECESSITY definition
MEDICALLY NECESSITY means any medical service or medical supply which is used to identify or treat an illness or injury, is appropriate to the patient's diagnosis and status of recovery, recommended to the self-insured employer or carrier in writing by an authorized treating physician, and is consistent with the location of service, the level of care provided, and the utilization review requirements consistent with this section applicable practice parameters. The service should be widely accepted among practicing health care providers, based on scientific criteria, and determined to be reasonably safe. The service must not be of an experimental, investigative, or research in nature. ,except in those instances in
MEDICALLY NECESSITY or "MEDICAL NECESSITY" shall mean services or supplies (including drugs) provided to a Subscriber by Agency, physician or other providers that are required to identify or treat a patient's illness or injury and which as determined by BCBST are:
MEDICALLY NECESSITY. (ary)” means, unless otherwise defined by the Payor in its Health Benefits Plan, those services determined by the Payor or its Designated Representative to be (i) preventative, diagnostic, and/or therapeutic in nature, (ii) specifically related to the condition which is being treated/evaluated, (iii) rendered in the least costly medically appropriate setting (e.g., inpatient, outpatient, office), based on the severity of illness and intensity of service required, and (iv) not primarily for the Member’s convenience or that of his or her physician.