Common use of Investigative Clause in Contracts

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 diagnostic testing and medical treatment and prescription drug use which is medically appropriate to the member's physical or mental diagnosis for an injury or illness, and preventive services covered in this Contract. Medically necessary care must meet the following criteria:

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 diagnostic testing and medical treatment and prescription drug use which is medically appropriate to the member's physical or mental diagnosis for an injury or illness, and preventive services covered in this Contract. Medically necessary care must meet the following criteria: