Investigative. As determined by us, a drug, device or medical treatment or procedure is investigative if reliable evidence does not permit conclusions concerning its safety, effectiveness, or positive effect on health outcomes. We will consider the following categories of reliable evidence, none of which shall be determinative by itself: Medically Necessary Care. This is health care services appropriate, in terms of type, frequency, level, setting and duration, to the enrollee’s diagnosis or condition, and diagnostic testing and preventive services. Medically necessary care must be consistent with generally accepted practice parameters as determined by health care providers in the same or similar general specialty as typically manages the condition, procedure, or treatment at issue, and must:
Appears in 5 contracts
Samples: Membership Contract, Membership Contract, Membership Contract
Investigative. As determined by us, a drug, device or medical or dental treatment or procedure is investigative if reliable evidence does not permit conclusions concerning its safety, effectiveness, or positive effect on health outcomes. We will consider the following categories of reliable evidence, none of which shall be determinative by itself: Medically Necessary Care. This is health care services appropriate, in terms of type, frequency, level, setting and duration, to the enrollee’s diagnosis or condition, and diagnostic testing and preventive services. Medically necessary care must be consistent with generally accepted practice parameters as determined by health care providers in the same or similar general specialty as typically manages the condition, procedure, or treatment at issue, and must:
Appears in 4 contracts
Samples: Membership Contract, Membership Contract, Membership Contract