What does “Medically Necessary” mean to my Medicare coverage?

The term “Medically Necessary strikes fear in the hearts of all that are a part of Medicare coverage across the country.  Somebody, somewhere in some dark room decided that whatever you deem necessary to live a good life is not “Medically Necessary” so you are out of luck.  Or are you?  Consider the following ways to determine if something is “Medically Necessary” and if your situation qualifies:

1. Are proper and needed for diagnosis, or treatment of your medical condition.  This could be something that your doctor needs or that you need in the course of your medical condition.
2. Are provided for the diagnosis, direct care, and treatment of your medical condition.  Again the word “treatment” appears in the definition, this word is tricky because many things seem necessary treatment and maybe not “Medically Necessary.
3. Meet the standards of good medical practice in the medical community of your local area.   This term seems a bit askew because why would someone in another state or county be ok to use the services or procedures, but not you?
4. Are not mainly for the convenience of you or your doctor.  This is for a very obvious and simple reason as Medicare coverage wants to avoid paying for tools or services that could be a conflict of interest.

Filed under: General-Medicare