Common use of Medical Necessity Examples Clause in Contracts

Medical Necessity Examples. Examples of hospitalization and other Health Care Services that are not Medically Necessary include: i. staying in the Hospital because arrangements for discharge have not been completed; ii. staying in the Hospital because supervision in the home, or care in the home, is not available or is inconvenient; or being hospitalized for any service which could have been provided adequately in an alternate setting (e.g., Hospital outpatient department); iii. inpatient admissions to a Hospital, Skilled Nursing Facility, or any other facility for the purpose of Custodial Care, convalescent care, or any other service primarily for the convenience of a Member, his family members or a provider; or iv. use of laboratory, x-ray, or other diagnostic testing that has no clear indication, or is not expected to alter your treatment.