Medical Management. The benefits available to You under this Contract may be subject to pre-service, concurrent and retrospective reviews to determine when services should be covered by Us. The purpose of these reviews is to promote the delivery of cost-effective medical care by reviewing the use of procedures and, where appropriate, the setting or place the services are performed. Covered Services must be Medically Necessary for benefits to be provided.
Appears in 45 contracts
Samples: Preferred Provider Organization Contract, Preferred Provider Organization Contract, Preferred Provider Organization Insurance Contract
Medical Management. The benefits available to You under this Contract Policy may be subject to pre-service, concurrent and retrospective reviews to determine when services should be covered by Us. The purpose of these reviews is to promote the delivery of cost-effective medical care by reviewing the use of procedures and, where appropriate, the setting or place the services are performed. Covered Services must be Medically Necessary for benefits to be provided.
Appears in 10 contracts
Samples: Participating Provider Organization Insurance Policy, Insurance Policy, Insurance Policy
Medical Management. The benefits available to You under this Contract may be subject to pre-service, concurrent and retrospective reviews to determine when services should be covered Covered by Us. The purpose of these reviews is to promote the delivery of cost-effective medical care by reviewing the use of procedures and, where appropriate, the setting or place the services are performed. Covered Services must be Medically Necessary for benefits to be provided.
Appears in 9 contracts
Samples: Preferred Provider Organization Contract, Preferred Provider Organization Contract, Preferred Provider Organization Contract
Medical Management. The benefits available to You under this Contract Certificate may be subject to pre-service, concurrent and retrospective reviews to determine when services should be covered Covered by Us. The purpose of these reviews is to promote the delivery of cost-effective medical care by reviewing the use of procedures and, where appropriate, the setting or place the services are performed. Covered Services must be Medically Necessary for benefits to be provided.
Appears in 1 contract
Samples: Student Vision Insurance Policy
Medical Management. The benefits available to You under this Contract may be subject to pre-service, concurrent and retrospective reviews to determine when services should be covered by Us. The purpose of these reviews is to promote the delivery of cost-effective medical care by reviewing the use of procedures and, where appropriate, the setting or place the services are performed. Covered Services must be Medically Necessary for benefits to be provided.provided.β
Appears in 1 contract
