Medically Necessary

Definition - What does Medically Necessary mean?

Medically necessary, in the context of insurance, refers to covered health care treatment or services vital to preserve the health of the patient. Therefore, if a patient requires a medically necessary treatment and does not receive it, they could suffer severe health consequences or even death as a result.

Insuranceopedia explains Medically Necessary

Medically necessary is an important distinction for health insurance because it determines whether or not a policy covers certain treatments or procedures. For example, many health insurance policies will cover health care services, such as repairing a broken leg, treating a life-threatening infection, and so on, because they are considered "medically necessary." However, procedures, such as breast implants, would typically not be medically necessary nor covered.

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