Most Health Plan Contracts Provide an Outline of the Criteria

question 109

Multiple Choice

Most health plan contracts provide an outline of the criteria that a healthcare service must meet in order to be considered "medically necessary." Typically, in order for a healthcare service to be considered medically necessary, the service provided by a physician or other healthcare provider to identify and treat a member's illness or injury must be

• A) Consistent with the symptoms of diagnosis
• B) Furnished in the least intensive type of medical care setting required by the member's condition
• C) In compliance with the standards of good medical practice
• D) All of the above

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Definitions:

Consciousness

The state of being aware of and able to think about one's own existence, sensations, thoughts, surroundings, and experiences.

Accessibility

The ease with which information, services, or physical spaces can be reached or utilized, particularly by people who experience disadvantages.

Association

A connection or relationship between ideas, objects, or events, often formed through experience or learning.

Mainstream Media

Traditional forms of mass communication, such as newspapers, television, and radio, that reach a large audience and have significant influence on public opinion and culture.