What Does the Term ‘Medical Necessity’ Mean?

Thursday, 05 August 2021

Medical Necessity

Have you ever heard the term ‘medical necessity’ used by your doctor or insurance company and wondered if it’s something you should pay attention to?

Well, we think you should, and here’s why:

In the insurance contract between your insurance company and your provider, the insurance company will pay on claims submitted if they are coded as ‘medically necessary’ or as a ‘medical necessity’.
A medical necessity is when a doctor deems a service or treatment to be critical to your treatment plan. It must be something evidence based on a positive outcome.

So, if your insurance company is denying a claim, one of the reasons could be that your provider is not coding the procedure or service as medically necessary. Always make sure before services are rendered that it’s going to be coded correctly by your doctor’s office.

If you have any questions regarding medical necessity or would like to review your group health benefits, give Clevenger Insurance a call today at 574-267-2181.

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