Medically Necessary Covered Service definition

Medically Necessary Covered Service means those covered services provided by qualified service providers within the scope of their practice to prevent disease, disability and other adverse health conditions or their progression or to prolong life.
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Examples of Medically Necessary Covered Service in a sentence

  • The HMO must ensure that each Member has access to a second opinion regarding the use of any Medically Necessary Covered Service.

  • If You require a Medically Necessary Covered Service that is not available through a Network Provider and We approve Your Network Provider’s referral, We will cover the service as if it were performed by a Network Provider.

  • These minimum requirements do not release the Health Plan from the requirement to provide or arrange for the provision of any Medically Necessary Covered Service required by its Enrollees.

  • The request by a Member for a Medically Necessary Covered Service.

  • Services Subject to Preauthorization If You require a Medically Necessary Covered Service that is not available through a Network Provider and We authorized Your Network Provider’s Referral, We will cover the service from the Non-Network Provider as if it were performed by a Network Provider.

  • If you choose to receive a service that has been determined not to be a Medically Necessary Covered Service, you will be responsible for paying all charges and no benefits will be paid.

  • The MCO must ensure that each Member has access to a second opinion regarding the use of any Medically Necessary Covered Service.

  • Participating Facility shall not charge Medicaid Members for any service that (i) is not a Medically Necessary Covered Service; (ii) that there may be other Covered Services available to meet the Medicaid Member’s needs; and (iii) where the Participating Facility did not explain items (i) and (ii) and (iii), that the Medicaid Member will be liable to pay the Participating Facility for the provision of any such services.

  • Participating Practice shall not charge Medicaid Members for any service that (i) is not a Medically Necessary Covered Service; (ii) that there may be other Covered Services that are available to meet the Medicaid Member’s needs; and (iii) where Participating Practice did not explain items (i) and (ii) and (iii), that the Medicaid Member will be liable to pay Participating Practice for the provision of any such services.