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Glossary
Medically necessary health care services are those required to diagnose or treat a condition and meet accepted medical practices.
When reviewing claims (opens in new tab) or requests for prior authorization (opens in new tab) for services or drugs, insurance providers look to verify whether services and supplies are medically necessary – that is, required to diagnose or treat an illness, injury, condition, or disease, and meet accepted medical practices.
Some types of health services, such as Lasik or cosmetic surgery, are not considered medically necessary by your insurance company. But other types of services can be trickier to categorize. Contact your insurer to check if your services are covered as medically necessary under your health plan benefits (opens in new tab).