BMC HealthNet Plan is committed to providing high-quality, health benefits to its members through the full integration of medically necessary medical/surgical and behavioral health services. See Section 5.11.2 of the BMC HealthNet Plan Provider Manual for Plan guidelines on new technology and experimental treatment. The Plan defines medically necessary services as those services:

• Which are reasonably calculated to prevent, diagnose, prevent the worsening of, alleviate, correct, or cure conditions in the member that endanger life, cause suffering or pain, cause physical deformity or malfunction, threaten to cause or to aggravate a disability, or result in illness or infirmity; and
• For which there is no other healthcare service or site of service, comparable in effect, available, and suitable for the member requesting the service that is more conservative or less costly. Medically necessary services must be of a quality that meets professionally recognized standards of health care, and the services must be substantiated by records that include evidence of such medical necessity and quality.