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 Health Care Provider which is necessary, as determined by AvMed, for the diagnosis, care or treatment of a Member's Condition 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.

Appears in 5 contracts

Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract, Medical and Hospital Service Contract

AutoNDA by SimpleDocs

Medically Necessary. or Medical Necessity means the use of any appropriate medical treatment, service, equipment and/or supply as provided by a Health Care Provider which is necessary, as determined by AvMed, for the diagnosis, care or treatment of a Member's Condition 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 Attending 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.

Appears in 5 contracts

Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract, Medical and Hospital Service Contract

AutoNDA by SimpleDocs
Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!