Medically necessary

Medically Necessary is a term used in the Healthcare industry to describe medical services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms. These services or supplies must meet accepted standards of medicine.

Definition

In the United States, the term "medically necessary" is defined by Medicare as services or supplies that are needed for the diagnosis or treatment of a medical condition, and meet accepted standards of medical practice. This includes inpatient and outpatient services, prescription drugs, and durable medical equipment.

Determination

The determination of whether a service or supply is medically necessary is made by the patient's healthcare provider. This determination is based on the provider's professional judgment and the patient's individual health needs.

Coverage

Health insurance companies often use the term "medically necessary" in their coverage policies. If a service or supply is deemed medically necessary, it is typically covered by the insurance company. However, if a service or supply is deemed not medically necessary, it may not be covered.

Controversies

There are often controversies and disagreements over what is considered medically necessary. These controversies can arise between patients and their healthcare providers, or between patients and their insurance companies. In some cases, these disagreements can lead to legal disputes.

See also

• Healthcare
• Medicare
• Health insurance
• Medical necessity

Medically necessary Resources
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