Experimental Treatment definition

Experimental Treatment means in Our discretion a treatment, drug, device, procedure, supply or service and related services (or any portion thereof, including the form, administration or dosage) for a particular diagnosis or condition when any one of the following exists:

Experimental Treatment means any mental health or developmental disabilities treatment that presents significant risk of physical harm, but does not include accepted treatment used in competent practice of medicine and psychology and supported by scientifically acceptable studies;

Experimental Treatment means a therapy, intervention or procedure (not standard of care) delivered to a specific individual patient for therapeutic purposes in an attempt to cure or alleviate symptoms.

Examples of Experimental Treatment in a sentence

• Experimental Treatment — A course of treatment, procedure, device or other medical intervention that is not yet recognized by the professional medical community as an effective, safe and proven treatment for the condition for which it is being used.

• You may be eligible for an independent medical review if your grievance involves a claim or service for which coverage was denied on the grounds that the service is: • Not Medically Necessary; or • Experimental or Investigational (including the external review available under the Xxxxxxxx-Xxxxxxx Experimental Treatment Act of 1996).

• If your grievance involves a claim or Services for which coverage was denied by Blue Shield in whole or in part on the grounds that the service is not medically necessary or is experimental/investigational (including the external review available under the Xxxxxxxx- Xxxxxxx Experimental Treatment Act of 1996), you may choose to make a request to the Department of Managed Health Care to have the matter submitted to an independent agency for external review in accordance with California law.

• Experimental Treatment or SurgeryExperimental treatment or surgery is not covered.Filing FeesFiling Fees are not covered.HypnosisHypnosis is not covered.Laetrile TherapyLaetrile therapy is not covered.Mutually Exclusive ProceduresMutually exclusive procedures are those codes that cannot reasonably be done in the same session and are considered not separately allowable or reimbursable.

• Lifetime maximum of $1,750 per Covered Person.Benefits will not be paid under the Immunotherapy Benefit for any medications paid under the Experimental Treatment Benefit.

More Definitions of Experimental Treatment

Experimental Treatment means services or supplies, including treatments, procedures, hospitalizations, drugs, biological products or medical devices, which a peer review panel determines are not of proven benefit for the particular diagnosis or treatment of the covered person's particular condition, or not generally recognized by the medical community as effective or appropriate for the particular diagnosis or treatment of the covered person's particular condition, or provided or performed in special settings for research purposes or under a controlled environment or clinical protocol. Unless otherwise required by law with respect to drugs that have been prescribed for the treatment of a type of cancer for which the drug has not been approved by the United States Food and Drug Administration, the plan shall not cover any services or supplies including treatment, procedures, drugs, biological products, or medical devices or any hospitalization in connection with experimental or investigational services or supplies. The plan shall also not cover any technology or any hospitalization in connection with that technology if that technology is obsolete or ineffective and is not used generally by the medical community for the particular diagnosis or treatment of the covered person's particular condition. Governmental approval of a technology is not necessarily sufficient to render it of proven benefit or appropriate or effective for a particular diagnosis or treatment of the particular condition as provided in this subsection. The plan shall apply the following five (5) criteria in determining whether services or supplies are experimental or investigational:

Experimental Treatment means treatment that, while not commonly used for a particular condition or illness, nevertheless is recognized for treatment of the particular condition or illness, and there is no clearly superior, non-experimental treatment alternative available to the enrollee.

Experimental Treatment means treatment that, while not

Experimental Treatment means chemotherapy, or immunotherapy drugs not yet approved by the United States Food and Drug Administration for the treatment of Cancer which are the subject of ongoing clinical studies sponsored and funded by the National Cancer Institute to determine their toxicity, safety, efficacy or their efficacy compared to standard means of treatment. Treatment must be received in the United States or its territories and administered by an Oncologist as defined in this Policy and any issued Certificate. The Oncologist must certify, to the best of his or her knowledge and belief, that no other treatment having United States Food and Drug Administration approval is superior to the proposed Experimental Treatment.

Experimental Treatment means a service, supply, drug, device, procedure or therapy deemed experimental or investigational by any state or the federal government, or which meets one of the following conditions:

Experimental Treatment means any treatment other than one that is commonly accepted for treatment of the mental disorder involved (or is supported by widely accepted scientific studies) and is provided by a qualified health professional, if such treatment poses a significant risk of harm to the patient.

Experimental Treatment means an audiological or hearing aid service that is clinically unproven.] [(13)] (12) (text unchanged)