What is Medical Necessity?

You may hear a doctor or mental health professional use this term when speaking about appropriate behavioral or mental health treatment for you or your loved one. The term “medical necessity” means that the recommendations made by the doctor or mental health professional is a reasonable and necessary prescription for treatment pertaining to the diagnosis to improve the functioning of an individual.  When services are defined as a “medical necessity,” health insurance (or the payer) is responsible for reimbursement of the service.