Medically Necessary Services
Services or supplies as provided by a physician or other healthcare provider to identify and treat a member’s illness or injury, which, as determined by the payor, are consistent with the symptoms, diagnosis, and treatment of the member’s condition; in accordance with the standards of good medical practice; not solely for the convenience of the member, member’s family, physician, or other healthcare provider; and furnished in the least intensive type of medical care setting required by the member’s condition.
