Dentally Necessary means treatment, tests, services or supplies provided by a Hospital, Physician, or other Licensed Health Care Provider which are not excluded under this Plan and which meet all of the following criteria:
Dentally Necessary means a dental service or procedure required to establish or maintain a patient's dental health. The determination as to when a dental service is necessary shall be governed in accordance with guidelines established by the Company. In the event of a conflict of opinion between the treating dentist and the Company as to if a dental service or procedure is Dentally Necessary, the opinion of the Company shall be final.
Dentally Necessary means care which is limited to diagnostic examination, treatment, and the use of dental equipment and appliances and which is required to prevent deterioration of dental health, or to restore dental function. The member’s general health condition must permit the necessary procedure(s).
Examples of Dentally Necessary in a sentence
In addition, any charges for Medically Necessary and/or Dentally Necessary items that are excluded under the Policy are the responsibility of the Insured.
The benefits of this Policy are provided only for those services that are Dentally Necessary as defined in this Policy and for which the Insured Person has benefits.
The fact that a Dentist prescribes or orders a service does not, in itself, mean that the service is Dentally Necessary or that the service is a Covered Service.
In this instance, you can collect your full fee (subject only to the Agreement’s preconditions for billing of any services that are not Dentally Necessary or Experimental/Investigational).
Not Dentally Necessary or not deemed to be generally accepted standards of dental treatment.
More Definitions of Dentally Necessary
Dentally Necessary or "Necessary" means a service or supply needed to improve a specific condition or to preserve the Member’s dental health and which, as determined by LIBERTY is:
Dentally Necessary means dental services determined by a dentist to either establish or maintain a patient’s dental health based on the professional diagnostic judgment of the dentist and the prevailing standards of care in the professional community. This determination will be made by the dentist in accordance with guidelines established by the Plan.
Dentally Necessary means the extent of care and treatment which is the generally accepted, proven and established practice by most dentists with similar experience and training where the service is provided, as determined by HumanaDental. Such care and treatment must use the least costly setting or procedure required by the patient’s condition and must not be provided primarily for the convenience of the patient or the DENTIST.
Dentally Necessary or “Dental Necessity” means Dental Services that a Dentist, exercising prudent clinical judgment, would provide to a Patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are: (1) in accordance with generally accepted standards of dental practice; (2) clinically appropriate, in terms of type, frequency, extent, site and duration and considered effective for successfully treating the Patient's illness, injury or disease; and (3) not primarily for the convenience of the Patient, Dentist or other health care provider, and (4) not more costly than an alternative service or sequence of services fulfilling the requirements of the specific situation or the extenuating circumstances as to the diagnosis or treatment of that Patient's illness, injury or disease. For the purposes of this definition, "generally accepted standards of dental practice" means standards that are based on credible scientific evidence published in peer-reviewed dental literature generally recognized by the relevant dental community or otherwise consistent with the standards set forth in policy issues involving clinical judgment.
Dentally Necessary means treatment, tests, services or supplies provided by a Hospital, Physician or other Licensed Health Care Provider which are not excluded under this Plan and which meet all of the criteria defined in the Dental Benefit Determination Provisions section of this document.
Dentally Necessary or “Necessary” means a service or supply needed to improve a specific condition
Dentally Necessary or “Dentally Necessity” means services that include dental, goods or services furnished or ordered to: (i) meet the following conditions: (A) be necessary to protect life, to prevent significant illness or significant disability or to alleviate severe pain; (B) be individualized, specific and consistent with symptoms or confirm diagnosis of the illness or injury under treatment and not in excess of the patient's needs; (C) be consistent with the generally accepted professional dental standards as determined by the Program, and not be experimental or investigational; (D) be reflective of the level of service that can be furnished safely and for which no equally effective and more conservative or less costly treatment is available statewide; and (E) be furnished in a manner not primarily intended for the convenience of the enrollee, the enrollee's caretaker or the Dentist.