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Frequently Asked Questions

Is this REALLY medically necessary?

ZAP•FAQ
YES, if your doctor has performed an electrophysiology study and determined you are likely to suffer potentially fatal arrhythmia. Research posted in the spring of 2002 again verifies the life saving value of these devices: Suggesting it for most people who survive a heart attack that resulted in significant damage to the heart muscle. See below to understand how an ICD improves your chance of survival.

Are braces necessary?

FAQ About Braces
No. They are elective but people seldom grow out of the more severe problems. Braces treatment can prevent other unpleasant problems from developing later in life. See similar questions...

Is it medically necessary to treat the wetting?

Enuresis FAQ
No, it is not usually medically necessary to treat it. Once your doctor has helped you determine there is not a medical risk, your family can decide if you would like to pursue treatment. Most families prefer to work towards dryness rather than hope the wetting will be outgrown eventually. See similar questions...

How do I provide proof that the surgery is medically necessary?

Akron General Medical Center - Obesity Faq
Each individual will need to check with his or her policy and with a benefits representative about the documentation required. Typically, if the surgery is medically necessary, the surgeon will provide a letter stating so to the candidate’s insurance company, along with the request to provide surgery. The insurance company will then send a reply to the surgeon’s office, either approving or denying the request for surgery. See similar questions...

What are medically necessary contacts?

Member FAQ
Medically Necessary Contacts are required when a vision care provider has determined that spectacle lenses and frames would not achieve the best vision correction possible due to a medical condition. No. The Avesis plan does not cover medical or surgical treatment for eye disease or eye injury. You should contact your health plan for assistance in locating an appropriate medical vision provider. If you have a medical emergency, call 911 right away or go to the nearest hospital emergency room. See similar questions...

What are medically necessary services?

MWCC Weekly Orders
Medically necessary services are either those required for the remedial treatment or diagnosis of an on-the-job injury, a work-related illness, a pre-existing condition affected by the injury or illness, or a complication resulting from the injury or illness and for such period as the nature of the injury or process of recovery may require. See similar questions...

What does Medically Necessary mean?

Frequently Asked Questions, Health Insurance Indiana, Preexi...
Medically Necessary in a health insurance policy means a policy that excludes insurance coverage for medical treatment that is not considered medically necessary. See similar questions...

What is meant by medically necessary service?

Let's Get Together, Inc.
Specific billing instructions and guidelines will be provided with the card. The card will be able to be used for medical supplies, pharmacies, hearing aids, optical needs, and dental needs. It will be able to be used at hospitals, doctor's offices, and medical labs. See similar questions...

What are braces made from?

ADA.org: Oral Health Topics: Braces and Orthodontics Frequen...
Braces (also called orthodontic appliances) can be as inconspicuous—or as noticeable—as you like. Brackets—the part of the braces that attach to each tooth—are smaller and can sometimes be attached to the back of the tooth, making the brackets less noticeable. Brackets may be made of metal, ceramic, plastic or a combination of these materials. Some brackets are clear or tooth-colored. See similar questions...

CLAIM IT ISN'T MEDICALLY NECESSARY. CAN YOU HELP ME?

FAQ, Answers from the Obesity Law & Advocacy Center
We are fortunate to be able to help most anyone in this position and have a success rate overturning denials based on "medical necessity" or failure to meet criteria for surgery that is in excess of 90%. We can be most effective if we get the case or claim right at the time of the first denial. If you wish to inquire about us advocating for you in that type of case, click here. This is one of the areas we spend a great deal of time and have had very good success. See similar questions...

My claim was denied as not medically necessary. What does that mean?

Individual Medical Benefits Health Insurance Frequently Aske...
Please review your policy's definition of medical necessity. If you disagree with our determination, send an appeal in writing to the insurance company. See your policy package for more details. Note any extenuating details, include any documentation pertaining to the appeal, and keep a copy for your records. See similar questions...

My claim was denied because my insurance company said it wasn't medically necessary. Can you help?

FAQ
We are extremely successful in overturning denials based on lack of medical necessity. The success rate in overturning denials is over 90%. To be the most effective, it is important that you contact us when your claim or appeal is first denied. See similar questions...

What do the terms "medically necessary" or “medical necessity” mean?

How Do I... - BCBST.com
Medical services received must be medically necessary to be covered by the plan. The services must be of proven value for use in the general population and must meet the following criteria; have scientific evidence permitting conclusions concerning the beneficial effect of the service on health outcomes; demonstrate the improvement outside the investigational setting; and not be an experimental or investigational service. See similar questions...

What else should I consider?

Organ Transplant, SVCMC; New York NY
You may be worried about having an organ transplant, being in a transplant center or hospital, or being around medical equipment or doctors. You may have concerns that you will not survive the surgery. All are normal concerns. Most people who have undergone an organ transplant say it was a good decision, and that the surgery and lifelong use of medications and lifestyle changes are worth it. The quality of your life can greatly improve. You should have more energy soon after your transplant. See similar questions...

What should I do if my Plan or doctor says that the care I need is not "medically necessary"?

Benefits - Frequently Asked Questions
Ask your Plan for utilization review. Utilization review is a special appeal when your Plan or doctor thinks the medical care you want is not medically necessary. Medically necessary care is care that you need. Your Plan must decide your utilization review request within these times: business days if you need pre-authorization ahead of time. See similar questions...

Q5. May NPPs who are employed by the facility bill for medically necessary visits?

September 2005 Part B Medicare Bulletin
A5. Payment may be made for the services of Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs) who are employed by a SNF or NF when their services are rendered to facility residents. If NPs and CNSs employed by a facility opt to reassign payment for their professional services to the facility, the facility can bill the appropriate Medicare Part B carrier under the NPs’ or CNSs’ UPINs for their professional services. See similar questions...

Which precautions do you take? What do you consider as necessary?

Microscopy ListServer Archive Output
From: Nestor J. Zaluzec-Argonne Nat. Lab. : ZALUZEC-at-AAEM.AMC.ANL.GOV Date: Thu, 11 May 1995 10:50:40 -0500 (CDT) See similar questions...

Is there any medically proof?

Therapy Gloves - FAQ's about our Far Infrared Healing Gloves...
Numerous medical studies have proven the benefiting efficacy of far infrared. Dr. Sasaki Kyuo, M.D. has conducted the most extensive research on the therapeutic uses of far infrared therapy. She is the author of "The Scientific Basis and Therapeutic Benefits of Far Infrared Ray Therapy". Read more about research. See similar questions...

How do I take care of my braces?

Orthodontics and Braces FAQ's: Information on Orthodontic De...
always, it's very important to practice good oral hygiene by brushing and flossing after every meal. Hard and sticky foods should be avoided since they can damage your braces. Be sure to keep all of your orthodontic appointments and follow the instructions and recommendations given by your orthodontist. See similar questions...

What is the difference between all these braces?

ProCare FAQ
DJO Incorporated manufactures an array of products, including knee braces, walkers, upper extremity braces, and cold therapy products. Please check our product pages to read more about specific products. For DonJoy products, click here. For ProCare products, click here. Since many of these braces are sold by prescription only, we suggest patients seek advice from their medical provider to ensure they get the correct brace for their specific condition. See similar questions...

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