Medical necessity
Medical Necessity
Medical necessity (pronunciation: /ˈmɛdɪkəl nɪˈsɛsɪti/) is a term used in the healthcare industry to determine if a treatment, procedure, or hospitalization is reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care.
Etymology
The term "medical necessity" is derived from the English words "medical", pertaining to the science of healing, and "necessity", meaning the fact of being required or indispensable. The term is used in the context of healthcare to determine the need for a particular treatment or procedure.
Definition
In the context of healthcare, medical necessity refers to a decision by your health care provider that your treatment, tests, or procedures are necessary for your health or to treat a diagnosed medical condition. The concept of medical necessity is fundamental to the health insurance industry, as insurers often base coverage decisions on whether a treatment is deemed medically necessary.
Related Terms
- Healthcare: The organized provision of medical care to individuals or a community.
- Health Insurance: A type of insurance coverage that pays for medical and surgical expenses incurred by the insured.
- Clinical Standards of Care: The diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance.
- Evidence-Based Medicine: An approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research.
See Also
External links
- Medical encyclopedia article on Medical necessity
- Wikipedia's article - Medical necessity
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