Medical Necessity

Medical necessity refers to the healthcare services, tests, or treatments that are appropriate and essential to diagnose, prevent, or treat a medical condition, based on current medical standards and evidence. It ensures that patients receive interventions that are appropriate for their health needs and that the care provided is not excessive or unnecessary. Insurance companies often evaluate medical necessity to determine whether they will cover certain services, aiming to balance effective patient care with responsible resource use. Essentially, it’s about ensuring the care is appropriate and justified for the patient’s specific health situation.