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

• The Maximum Allowed Amount is the maximum amount of reimbursement Anthem will allow for services and supplies: • that meet Our definition of Covered Services, to the extent such services and supplies are covered under Your Contract and are not excluded; • that are Medically Necessary; and • that are provided in accordance with all applicable Prior Authorization, utilization management or other requirements set forth in your Contract.

• Our application of these rules does not mean that the Covered Services you received were not Medically Necessary.

• Any Medically Necessary human organ and tissue transplant as determined by Us including necessary acquisition costs and preparatory myeloblative therapy.

• We may inform you that it is not Medically Necessary for you to receive services or remain in a Hospital or other facility.

• Covered Services must be Medically Necessary for benefits to be covered.

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 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 any treatment, tests, medication, or stay in Hospital or part of a stay in Hospital which:

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

Medically Necessary means a medical service which is:-