Medically Appropriate means services and medical supplies required for prevention, diagnosis, or treatment of a physical or behavioral health condition or injuries that are:
medically approved means certified by a medical practitioner;
Medically necessary care means care that is (1) appropriate and consistent with and essential for the prevention, diagnosis, or treatment of a Patient’s condition; (2) the most appropriate supply or level of service for the Patient’s condition that can be provided safely; (3) not provided primarily
Medically accurate means verified or supported by research conducted in compliance with scientific methods and published in peer-reviewed journals, where appropriate, and recognized as accurate and objective by professional organizations and agencies with expertise in the relevant field, such as the federal Centers for Disease Control and Prevention, the American Public Health Association, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists.
Medically Necessary means a service which is appropriate and consistent with the treatment of the condition in accordance with accepted standards of community practice.
Medically Necessary Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:
Generally applicable environmental radiation standards means standards issued by the U.S. Environmental Protection Agency (EPA) under the authority of the Atomic Energy Act of 1954, as amended, that impose limits on radiation exposures or levels, or concentrations or quantities of radioactive material, in the general environment outside the boundaries of locations under the control of persons possessing or using radioactive material.
Developmentally appropriate means suitable to the chronological age range and developmental characteristics of a specific group of children.
Intensive Care Unit means an identified section, ward or wing of a hospital which is under the constant supervision of a dedicated medical practitioner(s), and which is specially equipped for the continuous monitoring and treatment of patients who are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the ordinary and other wards.
Palliative care means medical service rendered to reduce or moderate temporarily the intensity of an otherwise stable medical condition, but does not include those medical services ren- dered to diagnose, heal or permanently alleviate or eliminate a medical condition.
Preventive Care means certain Preventive Care services.
Medically fragile means the condition of a child who requires the availability of twenty-four-hour skilled care from a health care professional or specially trained staff or volunteers in a group care setting. These conditions may be present all the time or frequently occurring. If the technology, support and services being received by the medically fragile children are interrupted or denied, the child may, without immediate health care intervention, experience death.
Hospice Care means a coordinated program of active professional
Inpatient care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.
Primary care physician means a physician qualified to be an attending physician according to ORS 656.005(12)(b)(A) and who is a general practitioner, family practitioner, or internal medicine practitioner.
Outpatient means a person who is receiving care other than on an inpatient basis, such as: • in a provider’s office; • in an ambulatory surgical center or facility; • in an emergency room; or • in a clinic. .
Practice of medicine or osteopathic medicine means the prevention, diagnosis and treatment of
Nursing diagnosis means a judgment made by a registered nurse, following a nursing assessment of individuals and groups about actual or potential responses to health problems, which forms the basis for determining effective nursing interventions.
Drug therapy management means the review of a drug therapy regimen of a patient by one or more pharmacists for the purpose of evaluating and rendering advice to one or more practitioners regarding adjustment of the regimen.
In Patient Care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.
Palliative and supportive care means care and support aimed mainly at lessening or controlling pain or symptoms; it makes no attempt to cure the Covered Person's terminal Illness or terminal Injury.
Primary care-giver means a person who assumes the principal role of providing care and attention to a child.
PREVENTIVE CARE SERVICES means covered healthcare services performed to prevent the occurrence of disease as defined by the Affordable Care Act (ACA). See Preventive Care and Early Detection Services in Section 3. PRIMARY CARE PROVIDER (PCP) means, for the purpose of this plan, professional providers that are family practitioners, internists, and pediatricians. For the purpose of this plan, gynecologists, obstetricians, nurse practitioners, and physician assistants may be credentialed as PCPs. To find a PCP or check that your provider is a PCP, please use the “Find a Doctor” tool on our website or call Customer Service.
Practice of chiropractic means the adjustment of the 24 movable vertebrae of the spinal column,
Naturopathic physician means a person licensed to practice naturopathic medicine by the Oregon Board of Naturopathic Medicine.
Best management practice (BMP) means a structural device or nonstructural practice designed to temporarily store or treat stormwater runoff in order to mitigate flooding, reduce pollution, and provide other amenities.