What does "Medically Necessary" mean?

"Medically Necessary" refers to services that are essential for diagnosing, treating, or preventing a medical condition. This definition forms the foundation of many medical policies and insurance coverage determinations, as it establishes the criteria under which healthcare services are provided to patients. The term encapsulates the need for healthcare professionals to deliver interventions that directly address the health needs of individuals, thereby ensuring that patients receive appropriate and relevant care.

When determining whether a procedure or service is considered "medically necessary," factors such as the medical history of the patient, the severity of the condition, and established treatment protocols come into play. This is crucial in both individual patient care and for insurance reimbursement, as services deemed medically necessary are typically covered under health insurance plans.