{"data":{"id":"us-in/ic-27-1-37.5-5.4","jurisdiction":"us-in","citation":"IC 27-1-37.5-5.4","heading":"\"Medically necessary\"","body":"Sec. 5.4. As used in this chapter, \"medically necessary\" means a health care service that a prudent health care provider would provide to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or symptoms in a manner that is:\n(1) in accordance with generally accepted standards of medical practice;\n(2) clinically appropriate in terms of type, frequency, extent, site, and duration; and\n(3) not primarily for:\n(A) the economic benefit of the health plan or purchaser; or\n(B) the convenience of the health plan, patient, treating physician, or other health care provider.","path":["TITLE 27. INSURANCE","ARTICLE 1. DEPARTMENT OF INSURANCE","Chapter 37.5. Health Care Service Prior Authorization"],"source_url":"https://iga.in.gov/ic/2026/Title_27.html#27-1-37.5-5.4","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-25T05:39:04Z","sha256":"3e0f355dc7f09cba28af29eb0d4e2c4cda8299f270fc41314d9d4515996caa08","source_id":"us-in","stale":false,"prev":"us-in/ic-27-1-37.5-5","next":"us-in/ic-27-1-37.5-6"},"notice":"GroundRules: Original legal text. Not legal advice."}