medical necessity
Clinically required care
Medical necessity is a standard used in healthcare to determine whether a treatment, procedure, or service is essential for a patient's condition.
Insurance companies and regulatory bodies invoke medical necessity to decide what they will cover: The claim was denied because they didn't consider the surgery a medical necessity.
What qualifies varies by insurer and jurisdiction, making the term a frequent point of dispute between patients, doctors, and payers.
- pre-existing conditionHealth issue before coverage
- out of pocketPaid from personal funds
- patient advocacySupporting medical care rights
- clinical judgmentHealthcare provider's evaluative reasoning
- doctor's ordersPhysician's prescribed instructions
appeals process · claims processing · standard of care · informed consent · reimbursement policies · healthcare ethics · patient outcomes · duty of care · prior authorization · second opinion · prescription medications · preventive care · surgical procedures · risk assessment · confidentiality laws · emergency treatment · life or death · diagnostic imaging
- medical billingclaim, copay, copayment, co-payment, deductible
- legal defensesself-defense, alibi, affirmative defense, insanity defense, insanity
- utilization reviewprior authorization, preauthorization, precertification, clinical guidelines, approval
- insuranceinsurance, coverage, auto insurance, life insurance, home insurance
- health insurancepremium, deductible, copay, coverage, health insurance card
- legal necessitylegal justification, justification, legal excuse, duress, compulsion
medical necessityelective surgery
Non-urgent chosen operation
cosmetic surgery · cosmetic procedure · plastic surgery · body modification · cosmetic dentistry
medical necessityexperimental treatment
Unproven medical procedure being tested
medical necessitypersonal choice
cosmetic enhancement · body modification · vanity · self-improvement
medical, necessity, medic, medicine, medicinal, medically, medicate, medication, medicament