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.

For your main Discussion post, 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 and share which ‘side of the table’ (Provider vs. Payer) you would like to work in-if you had to choose.

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