Medically Necessary definition

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 means that a treatment, service, or supply:

Medically Necessary means the need to have medical service for the purpose of investigating or treating the relevant Disability in accordance with the generally accepted standards of medical practice and such medical service must –

Examples of Medically Necessary in a sentence

• If it is determined that the services were not Medically Necessary, were Experimental/Investigational/Unproven, were not performed in the appropriate treatment setting, or did not otherwise meet the terms and conditions of the Contract, the Member may be responsible for the full cost of the services.

• As described in this section, the Plan provides Benefits for Medically Necessary organ and tissue transplant procedures.

• The Contractor may not structure compensation to individuals or utilization management entities so as to provide inappropriate incentives for the individual or entity to deny, limit, or discontinue Medically Necessary Services to any Member.

• The Contractor shall refer Members to Providers enrolled in the Medicaid Fee-for- Service delivery system for all Medically Necessary Services not covered by the Contractor under the MississippiCAN Program.

• Utilization of and payments to Out-of-network Providers may, at Contractor’s option, be limited to the treatment of Emergency Medical Conditions, including Medically Necessary services rendered to the Member until such time as he or she may be safely transported to a network provider service location.

More Definitions of Medically Necessary

Medically Necessary means a treatment, service, or supply that is: 1) required to treat an Injury or Sickness; 2) prescribed or ordered by a Doctor or furnished by a Hospital; 3) performed in the least costly setting required by the Covered Person’s condition; and 4) consistent with the medical and surgical practices prevailing in the area for treatment of the condition at the time rendered. Purchasing or renting 1) air conditioners; 2) air purifiers; 3) motorized transportation equipment; 4) escalators or elevators in private homes; 5) eyeglass frames or lenses; 6) hearing aids; 7) swimming pools or supplies for them; and 8) general exercise equipment are not Medically Necessary. A service or supply may not be Medically Necessary if a less intensive or more appropriate diagnostic or treatment alternative could have been used. We may consider the cost of the alternative to be the Covered Expense.

Medically Necessary means services or supplies that, under the provisions of this Contract, are determined to be:

Medically Necessary means a service or supply which: (a) is recommended by the attending Legally Qualified Physician: (b) is appropriate and consistent with the diagnosis in accord with accepted standards of community practice: (c) could not have been omitted without adversely affecting an Insured’s condition or quality of medical care: (d) is delivered at the most appropriate level of care and not primarily for the sake of convenience: and (e) is not considered experimental unless coverage for experimental services or supplies is required by law.

Medically Necessary means there must be a medical need for the leave and that the leave can best be accomplished through an intermittent or reduced leave schedule.

Medically Necessary means services, tests, medicines or supplies rendered, supervised or ordered by a hospital, skilled nursing facility, doctor or other provider required to treat an illness or injury and customarily recognized within the medical profession as appropriate in the care and treatment of the diagnosed condition in the opinion of the Fund, subject to the Claims Review and Appeal procedures of this SPD.

Medically Necessary means that the medical services, diagnosis and / or treatments are:

Medically Necessary means that a treatment, service, or supply is: (1) is essential for diagnosis, treatment or care of the Injury or Sickness for which it is prescribed or performed; (2) meets generally accepted standards of medical practice; and (3) is ordered by a Physician and performed under his or her care, supervision or order.