Why it matters for better outcomes and coverage
Medical necessity ensures that health services are consistent with accepted standards of care and not provided for convenience. This principle is key to improving health outcomes and maintaining cost-effective, safe care.
What makes care medically necessary?
- Appropriate for diagnosing or treating a condition.
- Delivered according to accepted medical standards.
- Provided at the safest, most appropriate level of service.
- Determined by necessity, not convenience.
Clinically appropriate care:
- Evidence-based: Supported by scientific research and clinical guidelines.
- Person-centered: Tailored to individual needs and preferences.
- Effective: Proven to achieve desired health outcomes.
- Efficient: Maximizes resources without compromising quality.
Why it’s important:
- Cost-effectiveness: Avoids unnecessary treatment and reduces healthcare costs.
- Patient safety: Minimizes risk by preventing inappropriate interventions.
- Insurance coverage: Most plans require services to meet medical necessity criteria.
For more information or to schedule a visit with an EAP counselor:
Visit bhoptions.eapintake.com or call 1-800-280-3782, TTY 711.
You have the right to receive help and information in your language at no cost. To request an interpreter, call the toll-free member number on your plan ID card or plan documents.