Medically Necessary

What Does Medically Necessary Mean?

In the context of insurance, “medically necessary” refers to healthcare treatments or services essential for preserving the patient’s health. Therefore, if a patient requires medically necessary treatment and does not receive it, they may face severe health consequences or even death as a result.

Insuranceopedia Explains Medically Necessary

The term “medically necessary” is a crucial distinction in health insurance, as it determines whether a policy will cover specific treatments or procedures. For instance, many health insurance policies cover services like repairing a broken leg or treating a life-threatening infection because they are deemed medically necessary. In contrast, procedures such as breast implants are typically not considered medically necessary and are therefore not covered.

The same standard applies to pet insurance policies, where insurers also draw a line between care that’s medically required and care that’s elective, and the specific list of what each insurer approves can vary. Pre-existing conditions are a common sticking point, and how pet insurers determine what counts as a pre-existing condition often shapes which future treatments they will later classify as medically necessary.