Reference no: EM133512159

Health insurance companies cover services they define as medically necessary. Medical necessity is a decision made by a health plan as to whether the treatment, test, or procedure is necessary for a patient's health or to treat a medical problem. Third-party payers (aka Insurance companies or health plans) often require documentation to illustrate medical necessity for treatment before payment will be made.

Evaluate and examine medical necessity from a provider's (doctor, hospital, clinic, etc.) point of a view and from a payer's/health plan's (Aetna, Cigna, Affinity, Healthfirst, etc.) point of view.