What is a medical necessity review?

A medical necessity review is a process that is used by health insurance companies to determine whether a service or procedure is medically necessary for a patient in California. It is used to decide whether the requested service will be covered under the patient’s insurance policy. The process involves reviewing medical records, consulting with the patient’s physician, and comparing the patient’s situation to established medical standards. The purpose of the medical necessity review is to ensure that the services or procedures are medically necessary and appropriate for the patient. This means that they are intended to improve the patient’s health, not just provide comfort or convenience. The review may also determine if the service can be provided in a more cost-effective way. The medical necessity review is an important part of health insurance law in California. It can help ensure that patients get the care they need without wasting money on unnecessary procedures or treatments. It also helps to protect patients from receiving services that may not be the best or most cost-effective choice for them.

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What is a medical necessity review?

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