medically necessary


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Related to medically necessary: medically necessary care

medically necessary

A covered health service or treatment that is mandatory to protect and enhance the health status of a patient, and could adversely affect the patient’s condition if omitted, in accordance with accepted standards of medical practice.

When applied to hospitalisation, medically necessary means that a plan member’s acute care needs are such that he or she cannot receive safe and adequate care as an outpatient or at a lower level of care.

Medically necessary, criteria 
A. Appropriate for the symptoms and diagnosis or treatment of a condition, illness or injury.
B. Provides for the diagnosis or direct care and treatment of the condition, illness or injury.
C. In accordance with the standards of good medical practice in the service area.
D. Not primarily for the convenience of a plan member or a plan provider. 
E. The most appropriate level or type of service or supply that can safely be provided to the plan member.

medically necessary

Managed care adjective Referring to a covered service or treatment that is absolutely necessary to protect and enhance the health status of a Pt, and could adversely affect the Pt's condition if omitted, in accordance with accepted standards of medical practice. See Futility.
Medically necessary, criteria  
a. Appropriate for the Sx and diagnosis or treatment of a condition, illness or injury
b. Provided for the diagnosis or the direct care and treatment of the condition, illness or injury
c. In accordance with the standards of good medical practice in the service area
d. Not primarily for the convenience of a plan member or a plan provider
e. The most appropriate level or type of service or supply which can safely be provided to the plan member

med·i·cal·ly ne·ces·sary

(med'i-kăl-ē nes'ĕ-sar-ē)
Services or supplies needed for diagnosis, treatment, or care.

Patient discussion about medically necessary

Q. is it ok to use drugs for medical reasons? and who is to decide when is necessary to use drugs when needed?

A. Today the most used "medical" drugs are narcotics- for pain relief, for patients who suffer extreme pain. All sorts of Codaine and Morphine types are used and on a very wide basis, and they are specially perscribed for ones who need them.

More discussions about medically necessary
References in periodicals archive ?
At a nonjury trial, plaintiff testified that he had performed certain testing on the patient, based on a referral from an orthopedic surgeon, without having inquired as to whether the testing was medically necessary.
If these cuts are implemented as proposed statewide, it is estimated that 60,000 severely disabled pediatric patients could lose access to medically necessary services," state Rep.
It must limit amounts charged for emergency or other medically necessary care to individuals eligible for assistance under the hospital's FAP;
On review, the denial was subsequently upheld because "Air Ambulance transportation from hospital to hospital is not covered under the plan, and any other transportation must be medically necessary.
10) Harlick claimed that Blue Shield was required to pay for the entirety of her treatment at Castlewood either because it was medically necessary residential treatment covered by her insurance plan, or, in the alternative, because the treatment had to be covered in accordance with the terms of the Parity Act.
A therapy could be considered medically necessary if the therapy could help a child "achieve or maintain maximum functional capacity in performing daily activities, taking into account both the functional capacity of the individual and the functional capacity of other persons of the individual's age," according to the text of S.
In light of these deficiencies, Health Canada is allowing only the importation of drugs deemed medically necessary from the BVL site.
Following Brett's argument, because the additional two days of personal care services, which were provided by her daughter were medically necessary but not covered in her Choices plan, they were deductible despite the fact that they might be covered if she made a request for them.
MOST people in Coventry and Warwickshire would only have cosmetic surgery if it was medically necessary, according to a website survey.
Women who underwent a medically necessary cesarean section most often did so because they had had a previous cesarean delivery (24%).
DC joins 4 states that voluntarily fund all or most medically necessary abortions, and 13 others forced to do so by court order.
Specifically, Michelle's Law prevents a group health plan from terminating coverage of a dependent child due to a medically necessary leave of absence, before the earlier of:

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