695G.055 - “Medically necessary” defined. - Nevada Statutes

695G.055  “Medically necessary” defined.  “Medically necessary” means health care services or products that a prudent physician would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and:

      1.  Provided in accordance with generally accepted standards of medical practice;

      2.  Clinically appropriate with regard to type, frequency, extent, location and duration;

      3.  Not primarily provided for the convenience of the patient, physician or other provider of health care;

      4.  Required to improve a specific health condition of an insured or to preserve the existing state of health of the insured; and

      5.  The most clinically appropriate level of health care that may be safely provided to the insured.

      (Added to NRS by 2003, 779)