Not medically necessary definition
Not medically necessary means an item or service which is not consistent with the
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.