medical policy

Medical policy refers to the set of guidelines that healthcare providers, insurers, and organizations follow to determine how medical services are provided, approved, and paid for. These policies help ensure consistent, fair, and effective delivery of healthcare by establishing criteria for treatments, medications, and procedures. They are based on medical evidence, best practices, and cost considerations to promote quality care while managing resources efficiently. Essentially, medical policy guides decision-making to balance patient needs with safety, affordability, and accountability within the healthcare system.