coverage policies

Coverage policies are guidelines that insurance companies use to determine which medical services, treatments, or medications they will pay for. They are based on medical necessity, effectiveness, safety, and cost. These policies help ensure that insurance funds are used appropriately while providing necessary care to policyholders. When a service is covered, the insurer agrees to pay part or all of the cost; if not, the insured may need to cover it themselves or seek alternative options. Coverage policies help manage healthcare costs and ensure consistent decision-making across similar cases.