US Medical Term · insurance
Medical Necessity
Necesidad médica
In 9 languages
| Language | Term |
|---|---|
| English | Medical Necessity |
| Spanish (Español) | Necesidad médica |
| Chinese (中文) | 醫療必要性 |
| Korean (한국어) | 의료 필요성 |
| Vietnamese (Tiếng Việt) | Sự cần thiết y tế |
| Filipino (Tagalog) | Medikal na pangangailangan |
| Portuguese (Português) | Necessidade médica |
| Thai (ภาษาไทย) | ความจำเป็นทางการแพทย์ |
| Japanese (日本語) | 医療上の必要性 |
What it means
Medical necessity is a standard insurers use to determine whether a service, treatment, or supply is appropriate and will be covered. To meet this standard, a service must generally be consistent with accepted medical practice, appropriate to the patient's diagnosis, not primarily for the patient's or provider's convenience, and no more intensive than the condition requires. Insurers compare services against clinical guidelines and evidence-based criteria. Services that do not meet medical necessity standards are denied as not covered. If your claim is denied for this reason, your doctor can provide supporting documentation and you can file an appeal with clinical evidence to challenge the decision.
How to say it
Sentences a patient might use with a doctor, nurse, pharmacist, or insurer:
My claim was denied as not medically necessary — how do I challenge this determination?
Mi reclamo fue denegado por no ser médicamente necesario — ¿cómo puedo impugnar esta determinación?
What clinical criteria does your plan use to evaluate medical necessity?
¿Qué criterios clínicos usa su plan para evaluar la necesidad médica?
My doctor can provide documentation supporting the medical necessity of this treatment.
Mi médico puede proporcionar documentación que respalde la necesidad médica de este tratamiento.
Where you'll see it
Related terms
Sources
Last reviewed: September 2026