medically necessary care

medically necessary care,

n the reasonable and appropriate diagnosis, treatment, and follow-up care (including supplies, appliances, and devices) as determined and prescribed by qualified appropriate health care providers in treating any condition, illness, disease, injury, or birth de-velopmental malformation. Care is medically necessary for the purpose of controlling or eliminating infection, pain, and disease and restoring facial configuration or function necessary for speech, swallowing, or chewing.
References in periodicals archive ?
Not use gross charges and limit the amounts charged for emergency or other medically necessary care provided to individuals eligible under the FAP to not more than the amounts generally billed (AGB) to individuals who have insurance covering such care; and
If employees have to bear more of the cost, will they skimp on medically necessary care, curtail the use of less valuable services, or both?
Chrysler Group's 100 percent rating also signifies coverage for transgender individuals for medically necessary care - a community the HRC notes has historically been overlooked.
2) In addition to potentially harming the patient through delayed direct medical care, delays in obtaining prior approval to commence care or a coverage decision regarding medically necessary care can result in frustration, concern and professional dissatisfaction for the provider.
That is defined as equal health coverage for transgender individuals without exclusion for medically necessary care, without blanket exclusions, and based on the World Professional Association for Transgender Health Standards of Care.
It pays only for medically necessary care in a skilled nursing facility or home health care.
Under this provision, no detail is given as to what is considered "other medically necessary care.
Anthem, a class-action suit by nonphysician providers against insurance companies, charging that the companies conspired to systematically underpay providers and deny medically necessary care to patients.
Many prisons, for example, use restrictions to limit treatment eligibility and avoid the cost of medically necessary care.
Romanow states that "essential health care services must be available to all Canadians on the basis of need and need alone" (27) and argues the health care system currently falls below what a truly comprehensive, publicly insured system of medically necessary care would provide:
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