“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)