1.Does the technology have final approval from the appropriate goverment regulatory body?
2.Does scientific evidence permit conclusions concerning the effect of technology on health care outcomes?
3.Does it improve net health care outcomes?
4.Is it as beneficial as well established alternatives?
5.Are there improvement gained that are attainable outside the investigtional setting?
6.Is the denial of experimental/ investigational supported in consideration of all of the tiems listed by the TEC criteria and terms of medical policy and contractual definition?
7.Does the application of client’s TEC criteria make for a logical, clinically based and resonable guidelines for determining what is experiemtnal/ investigational?
8.Is there anything specific to this case which would support overturning or uphodlnig the denial? Would you overturne or uphold the denial?
9./Were CareFirst guidelines appropriately applied?