Medically Necessary

What Does Medically Necessary Mean?

In the context of insurance, “medically necessary” refers to healthcare treatments or services essential for preserving the patient’s health. Therefore, if a patient requires medically necessary treatment and does not receive it, they may face severe health consequences or even death as a result.

Insuranceopedia Explains Medically Necessary

The term “medically necessary” is a crucial distinction in health insurance, as it determines whether a policy will cover specific treatments or procedures. For instance, many health insurance policies cover services like repairing a broken leg or treating a life-threatening infection because they are deemed medically necessary. In contrast, procedures such as breast implants are typically not considered medically necessary and are therefore not covered.