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Medically Necessary

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.

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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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