Medically Necessary

Medically necessary describes any service, treatment, or supply required to diagnose, treat, or manage a health condition, rather than for convenience, appearance, or personal preference. Insurers use this term to determine whether a claim qualifies for payment under your policy.

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For example, physiotherapy after a surgery may be medically necessary, while cosmetic Botox for appearance is not. The assessment is based on a physician’s recommendation and the insurer’s criteria for necessity.

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Example:

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If your doctor prescribes compression stockings to treat poor circulation, the expense may qualify as medically necessary and therefore reimbursable.

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What to Watch For:

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Even when prescribed, an item must still meet the insurer’s criteria for necessity and frequency. Always check coverage rules before purchase or treatment.