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.