EXPERIMENTAL OR INVESTIGATIONAL definition

EXPERIMENTAL OR INVESTIGATIONAL means any healthcare service that has progressed to limited human application, but has not been recognized as proven and effective in clinical medicine. See Experimental or Investigational Services in Section 3 for a more detailed description of the type of healthcare services we consider experimental or investigational.

EXPERIMENTAL OR INVESTIGATIONAL means that we determine the Service is:

EXPERIMENTAL OR INVESTIGATIONAL means the use of any treatment, procedure, facility, equipment, drug, device, or supply not accepted as standard medical treatment of the condition being treated or any of such items requiring Federal or other governmental agency approval not granted at the time services were provided.

Examples of EXPERIMENTAL OR INVESTIGATIONAL in a sentence

• SERVICES DENIED AS EXPERIMENTAL OR INVESTIGATIONAL 13 PART IV: COVERED SERVICES 14 A.

• The following transplants are covered in the benefit package: heart transplants, lung transplants, heart-lung transplants, liver transplants, kidney transplants, autologous bone marrow transplants, allegoric bone marrow transplants and corneal transplants, as detailed in MAD Program Manual Section MAD-764, TRANSPLANT SERVICES, Section MAD-765, EXPERIMENTAL OR INVESTIGATIONAL PROCEDURES, TECHNOLOGIES, OR NON-DRUG THERAPIES.

• The CONTRACTOR shall not deem a technology or its application experimental, investigational or unproven and deny coverage unless that technology or its application fulfills the definition of “experimental, investigational or unproven” contained in the MAD Program Policy Manual, Section 765, EXPERIMENTAL OR INVESTIGATIONAL PROCEDURES, TECHNOLOGIES OR THERAPIES.

More Definitions of EXPERIMENTAL OR INVESTIGATIONAL

EXPERIMENTAL OR INVESTIGATIONAL means a service that is determined to be experimental or investigational. In determining whether services are Experimental or Investigational, the Company will consider the following:

EXPERIMENTAL OR INVESTIGATIONAL. : means any procedure, treatment, facility, supply, device, or drug that:

EXPERIMENTAL OR INVESTIGATIONAL means, except as provided for under any clinical trials benefit provision, a drug, a device, a procedure, or treatment where:

EXPERIMENTAL OR INVESTIGATIONAL means any portion or part of any procedure, device, drug, treatment, or medicine, or the use thereof, which falls within any of the following categories:

EXPERIMENTAL OR INVESTIGATIONAL means that the Claims Administrator determines the Service is:

EXPERIMENTAL OR INVESTIGATIONAL means that it is determined that the Service is:

EXPERIMENTAL OR INVESTIGATIONAL means care and treatment which does not constitute accepted medical practice properly within the range of appropriate medical treatment under the standards of the case and by standards of a reasonably substantial, qualified, responsible, relevant segment of the medical community. The Plan Administrator shall be guided by a reasonable interpretation of Plan provisions. The decisions shall be made in good faith and rendered following a detailed factual background investigation of the claim and the proposed treatment. W hen making an independent evaluation of the experimental/non experimental standings of specific technologies, the Plan Administrator will be guided by the following principles: