Common use of Medically Necessary Clause in Contracts

Medically Necessary. or Medical Necessity means the use of any appropriate medical treatment, service, equipment and/or supply as provided by a Hospital, Skilled Nursing Facility, Physician or other provider which is necessary, as determined by AvMed, for the diagnosis, care or treatment of a Member's illness or injury and which is: a. consistent with the symptoms, diagnosis and treatment of the Member's Condition; b. the most appropriate level of supply and/or service for the diagnosis and treatment of the Member's Condition; c. in accordance with standards of acceptable community practice; d. not primarily intended for the personal comfort or convenience of the Member, the Member's family, the Physician or other Health Professionals; e. approved by the appropriate medical body or health care specialty involved as effective, appropriate, and essential for the care and treatment of the Member's Condition; and f. not Experimental or Investigational.