Definitions
Health Insurance Terms
Medical Necessity

Medical Necessity

Definition:

A medical procedure or service must be performed only for the treatment of an accident, injury or illness and is not considered experimental, investigational or cosmetic.

Application:

Insurance companies strictly apply the review of medical necessity. They do not cover any procedures that do not abide by its definition. To remove the risk of determining if an insurance company will pay for a particular procedure, it is appropriate to request a medical review prior to the procedure being performed.

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