Experimental or Investigative definition

Experimental or Investigative means treatments, devices or prescription medications which are recommended by a Physician, but are not considered by the medical community as a whole to be safe and effective for the condition for which the treatments, devices or prescription medications are being used. This includes any treatments, procedures, facilities, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice, and any of those items requiring federal or other governmental agency approval not received at the time services are rendered.
Experimental or Investigative means a drug, device, medical treatment or procedure that:
Experimental or Investigative means treatment, a device or prescription medication which is recommended by a Physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device or prescription medication is being used. This includes any treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice, and any of those items requiring federal or other governmental agency approval not received at the time services are rendered.

Examples of Experimental or Investigative in a sentence

  • An Experimental or Investigative service is not made eligible for coverage by the fact that other treatment is considered by a Member’s Physician to be ineffective or not as effective as the service or that the service is prescribed as the most likely to prolong life.

  • But, if the Member is denied benefits because it is determined that the requested treatment is Experimental or Investigative, the Member may request an independent medical review as described in CLAIMS REVIEW /GRIEVANCE PROCEDURES.

  • MRIOA or AMR will review Your appeal to ensure the treatment is Medically Necessary and Appropriate, meets clinical guidelines, and is not Experimental or Investigative.

  • Treatments, procedures, equipment, drugs, devices or supplies (hereafter called "services") which are, in Anthem’s judgment, Experimental or Investigative for the diagnosis for which the Member is being treated.

  • Experimental/Investigative means any service or supply that is judged to be Experimental or Investigative at the Plan Administrator’s sole discretion.


More Definitions of Experimental or Investigative

Experimental or Investigative means treatment, a device or prescription medication which is recommended by a Physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device or prescription medication is being used. This includes any treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice, and any of those items requiring federal or other governmental agency approval not received at the time services are rendered. “Family Member” means the Insured’s, or Traveling Companion’s spouse, Domestic Partner, Child, daughter-in- law, son-in-law, brother, sister, mother, father, grandparents, grandchild, step-child, step-brother, step-sister, step-parents, parents-in-law, brother-in-law, sister-in-law, aunt, uncle, niece, nephew, legal guardian, Caregiver, foster Child, ward,
Experimental or Investigative means treatment, a device or prescription medication which is recommended by a Physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device
Experimental or Investigative means treatments, devices or prescription medications which are recommended by a Physician, but are not considered by the medical community as a whole to be safe and effective for the condition for which the treatments, devices or prescription medications are being used. This includes any treatments, procedures, facilities, equipment, drugs, drug usage, devices, or supplies
Experimental or Investigative means treatments, devices or prescription medications which are recommended by a treating Physician, but are not considered by the medical community as a whole to be safe and effective for the condition for which the treatments, devices or prescription medications are being used. This includes any treatments, procedures, facilities, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice, and any of those items requiring federal or other governmental agency approval not received at the time services are rendered. The Company will consult with the treating Physician and licensed medical professionals as well as internal and external doctors on an as needed basis to determine if the above treatments, devices or prescriptions are Experimental or Investigative.
Experimental or Investigative means any treatments, procedures, facilities, equipment, drugs, drug usage, devices, or supplies:
Experimental or Investigative means in connection with a drug, device, treatment, or procedure that:
Experimental or Investigative means not approved or broadly accepted and recognized by the Canadian medical profession as an effective, appropriate and essential Medical Treatment of a Sickness or Injury, in accordance with Canadian medical standards.