Clinical Decisions

The health care professional treating any insured shall make all clinical decisions regarding the medical treatment to be provided to the insured, including the provision of durable medical equipment and hospital lengths of stay: (1) Clinical decisions shall be made in accordance with generally accepted principles of professional medical practice and in consultation with the insured. (2) Nothing contained in 958 CMR 3.100 shall be construed as altering, affecting or modifying either the obligations of any third party payor or the terms and conditions of any agreement or contract between either the treating health care professional or the insured and any third party. (3) Carriers shall pay for health care services ordered by a treating health care professional if the services are a covered benefit under the insured's health benefit plan, and the services are medically necessary.