Experimental Treatment definition
Examples of Experimental Treatment in a sentence
If your grievance involves a claim or Services for which coverage was denied by Blue Shield in whole or in part on the grounds that the service is not medically necessary or is experimental/investigational (including the external review available under the ▇▇▇▇▇▇▇▇- ▇▇▇▇▇▇▇ Experimental Treatment Act of 1996), you may choose to make a request to the Department of Managed Health Care to have the matter submitted to an independent agency for external review in accordance with California law.
Experimental Treatment — A course of treatment, procedure, device or other medical intervention that is not yet recognized by the professional medical community as an effective, safe and proven treatment for the condition for which it is being used.
You may be eligible for an independent medical review if your grievance involves a claim or service for which coverage was denied on the grounds that the service is: • Not Medically Necessary; or • Experimental or Investigational (including the external review available under the ▇▇▇▇▇▇▇▇-▇▇▇▇▇▇▇ Experimental Treatment Act of 1996).
If your grievance involves a claim or Services for which coverage was denied by Blue Shield in whole or in part on the grounds that the service is not medically necessary or is experi- mental/investigational (including the external re- view available under the ▇▇▇▇▇▇▇▇-▇▇▇▇▇▇▇ Experimental Treatment Act of 1996), you may choose to make a request to the Department of Managed Health Care to have the matter submit- ▇▇▇ to an independent agency for external review in accordance with California law.
Experimental Treatment – services for which there is insufficient authoritative evidence that such service is reasonably calculated to prevent, diagnose, prevent the worsening of, alleviate, correct, or cure conditions in the Enrollee that endanger life, cause suffering or pain, cause physical deformity or malfunction, threaten to cause or to aggravate a disability, or result in illness or infirmity.