Common use of Medically Appropriate Clause in Contracts

Medically Appropriate. The term “Medically Appropriate” means services and medical supplies which are required for prevention, diagnosis, or treatment of sickness or injury, and which are: 1.18.1 Consistent with the symptoms of a medical condition or treatment of a medical condition; 1.18.2 Appropriate with regard to standards of good medical practice and generally recognized by the medical scientific community as effective; 1.18.3 Not solely for the convenience of the Member or provider of the service or medical supplies; and 1.18.4 The most cost effective of the alternative levels of service or medical supplies which can be safely provided to the Member in HPSM’s judgment.

Medically Appropriate. The term “Medically Appropriate” means services and medical supplies which are required for prevention, diagnosis, or treatment of sickness or injury, and which are: 1.18.1 Consistent with the symptoms of a medical condition or treatment of a medical condition; 1.18.2 Appropriate with regard to standards of good medical practice and generally recognized by the medical scientific community as effective; 1.18.3 Not solely for the convenience of the HPSM Member or provider of the service or medical supplies; and 1.18.4 The most cost effective of the alternative levels of service or medical supplies which can be safely provided to the HPSM Member in HPSM’s judgment.