Not medically necessary definition

Not medically necessary means an item or service which is not consistent with the
View Source

Examples of Not medically necessary in a sentence

  • Cosmetic Not medically necessary Up to $130 allowance (member responsible for any cost exceeding the allowance) Includes contact lens fitting and suitability exam.

  • If any claim determination made by us meets one or more of the following conditions: • Not medically necessary • Cosmetic • Experimental or investigational treatment • Requires medical judgment then the appeal of the claim determination must include an Independent Review Organization (IRO) report that includes each panel member’s report and the panel’s consensus report.

  • If any claim determination made by us meets one or more of the following conditions: • Not medically necessary.

Related to Not medically necessary

  • Medically Necessary means a service which is appropriate and consistent with the treatment of the condition in accordance with accepted standards of community practice.

  • Medically necessary care means care that is (1) appropriate and consistent with and essential for the prevention, diagnosis, or treatment of a Patient’s condition; (2) the most appropriate supply or level of service for the Patient’s condition that can be provided safely; (3) not provided primarily

  • Medically Necessary Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:

  • Medically fragile means the condition of a child who requires the availability of twenty-four-hour skilled care from a health care professional or specially trained staff or volunteers in a group care setting. These conditions may be present all the time or frequently occurring. If the technology, support and services being received by the medically fragile children are interrupted or denied, the child may, without immediate health care intervention, experience death.

  • Medically necessary leave of absence means any change in enrollment at the post-secondary school that begins while the child is suffering from a serious illness or injury, is medically necessary, and causes the child to lose student status for purposes of coverage under the Plan.