Common use of Medical Necessity Determination Clause in Contracts

Medical Necessity Determination. Health Plan’s determination with regard to Medically Necessary services and scope of Covered Services, including determinations of level of care and length of stay benefits available under the Member’s health program shall govern. The primary concern with respect to all medical determination shall be in the interest of the Member.

Medical Necessity Determination. Health Plan’s determination with regard to Medically Necessary services and scope of Covered Provider Services, including determinations of level of care and length of stay benefits available under the Member’s health program shall will govern. The primary concern with respect to all medical determination shall determinations will be in the interest of the Member.

Medical Necessity Determination. Health Plan’s determination with regard to Medically Necessary services and scope of Covered Hospital Services, including determinations of level of care and length of stay benefits available under the Member’s health program shall will govern. The primary concern with respect to all medical determination shall determinations will be in the interest of the Member.

Medical Necessity Determination. Health Plan’s determination with regard to Medically Necessary services and scope of Covered Services, including determinations of level of care and length of stay benefits available under the Member’s health program shall govern. The primary concern with respect to all medical determination shall be in the interest of the Member.