Medically Appropriate

Services which have been determined by BlueCross BlueShield of Tennessee in its discretion to be of value in the care of a specific member.  To be medically appropriate a service must meet all of the following:

  1. Be medically necessary

  2. Be consistent with generally accepted standards of medical practice for the member’s medical condition

  3. Be provided in the most appropriate site and at the most appropriate level of service for the member’s medical condition

  4. Not be provided solely to improve a member’s condition beyond normal variation in individual development, appearance and aging

  5. Not be for the sole convenience of the provider, member or member’s family

This document has been classified as public information.