Routine Patient Costs definition

Routine Patient Costs means all health care services that are otherwise covered under the Group Contract for the treatment of cancer or other Life-threatening Condition that is typically covered for a patient who is not enrolled in an Approved Clinical Trial.

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Routine Patient Costs means the costs of all Medically Necessary items and health care services consistent with the Covered Services that are typically provided for a Qualified Individual who is not enrolled in a clinical trial that are incurred as a result of the item, device, or service being provided to the Qualified Individual for purposes of the clinical trial. Routine Patient Costs do not include the investigational item, device, or service itself; items or services that are provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical management of the patient; or a service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis.

Routine Patient Costs means the cost for all items and services consistent with the coverage provided under this Policy that is typically covered for you if you are not enrolled in a clinical trial.

Examples of Routine Patient Costs in a sentence

• Approved Clinical Trials — Benefits for Covered Services for Routine Patient Costs are provided in connection with a phase I, phase II, phase III, or phase IV clinical trial or other Life Threatening Disease or Condition and is recognized under state and/or federal law.

• If a service could be considered Experimental or Investigational for a given condition, we recommend a benefit determination in advance, because these services are not covered without Pre-Authorization, except when covered as Routine Patient Costs associated with an approved clinical trial.

• Costs associated with clinical trial participation are covered as follows: • Routine Patient Costs, defined as: Items or services that are typically provided under the plan for a member not enrolled in a clinical trial (e.g., usual care/standard care).

• A Member participating in an approved clinical trial conducted outside the Member’s state of residence will be covered if the plan otherwise provides Out-of-Network coverage for Routine Patient Costs.

• Benefits will be provided for Routine Patient Costs incurred during participation in Approved Clinical Trials by Qualified Individuals provided or arranged by a Health Care Practitioner for prevention, early detection and treatment studies on cancer or treatment of other Life-Threatening Conditions.

More Definitions of Routine Patient Costs

Routine Patient Costs means the costs of all Medically Necessary items and health care services consistent with the Covered Services that are typically provided for a Qualified Individual who is not enrolled in a clinical trial that are incurred as a result of the treatment being provided to the Qualified Individual for purposes of the clinical trial.

Routine Patient Costs means those costs that are for medically necessary services that are needed for the purposes of an approved clinical trial, including those provided by doctors, diagnostic or laboratory tests, and other services consistent with the customary standard of patient care and otherwise covered under the plan. Routine patient costs do NOT include the actual device, equipment, or drug that is being studied as part of the clinical trial.

Routine Patient Costs means all items and services that the Plan would otherwise cover if the Participant were not enrolled in a clinical trial.

Routine Patient Costs means those Covered Transplant Services associated with participation in a Cinical Trial including and directly related to a Covered Transplant Procedure. Routine Patient Costs does not include:

Routine Patient Costs means costs associated with the provision of services, including drugs, medical devices and services that would otherwise by covered under the Plan, if those drugs, medical devices and services were not provided in connection with an Approved Clinical Trial, including health services that are:

Routine Patient Costs means all items and services consistent with the coverage provided under the health benefit plan that is typically covered for a qualified individual who is not enrolled in a clinical trial. Routine patient costs do not include the investigational item, device, or service itself; items or services that are provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical management of the patient; or a service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis.

Routine Patient Costs means the cost for all items and services consistent with the coverage provided