Experimental or investigational services definition

Experimental or investigational services means health care items or services that are:

Experimental or investigational services means health care items or services that are either not generally accepted by informed health care providers in the United States as effective in treating a condition, illness, or diagnosis for which their use is proposed, or are not proven by medical or scientific evidence to be effective in treating a condition, illness, or diagnosis.

Experimental or investigational services means services, supplies, care and treatment which does not constitute accepted medical practice properly within the range of appropriate medical practice under the standards of the case and by the standards of a reasonably substantial, qualified, responsible, relevant segment of the medical and dental community or government oversight agencies at the time services were rendered. The Plan Administrator must make an independent evaluation of the experimental/nonexperimental standings of specific technologies. The Plan Administrator shall be guided by a reasonable interpretation of Plan provisions and may employ the services of such medical peer review service organizations as the Medical Review Institute or UMAC and utilize data obtained from such national assessment organizations as HCFA, the Office of Health Technology Assessment and Institutes of the Department of Health and Human Services to aid in its determination. The decisions shall be made in good faith and rendered following a detailed factual investigation of the claim and the proposed treatment. The decision of the Plan Administrator will be final and binding on the Plan. The Plan Administrator will be guided by the following principles:

Examples of Experimental or investigational services in a sentence

• Experimental or Investigative Services Experimental or investigational services or supplies, including any complications or effects of such services.

• Previously, benefits were available for lobar lung transplants performed at these types of facilities.• We revised our definition of Experimental or investigational services.

• Experimental or investigational services or supplies and related exams or consultations.

• Services we provide benefits for, as described in this brochure.Custodial care Deductible Durable medical equipment Experimental or investigational services Group health coverageTreatment or services, regardless of who recommends them or where they are provided, that could be rendered safely and reasonably by a person not medically skilled, or that are designed mainly to help the patient with daily living activities.

• Experimental or investigational services are not a covered benefit of the Plan.

• Extractions, dental caries, periodontics (including but not limited to gingivitis, periodontitis and periodontosis) or the correction of impactions will not be covered.• Services or supplies for the administration of anesthesia if the charges for surgery are not covered under the EMHP.• Services or supplies to the extent they are not covered by the hospital portion because you failed to follow Program Requirements.• Experimental or investigational services or supplies.