Most health plan contracts provide an outline of the criteria that a healthcare service must meet in order to be considered "medically necessary." Typically, in order for a healthcare service to be considered medically necessary, the service provided by a physician or other healthcare provider to identify and treat a member's illness or injury must be
A) Consistent with the symptoms of diagnosis
B) Furnished in the least intensive type of medical care setting required by the member's condition
C) In compliance with the standards of good medical practice
D) All of the above

Question

Quizplus · Accepted Answer

In order for a healthcare service to be considered medically necessary, it must fulfill all three requirements listed in choices A, B, and C. The service must be consistent with the symptoms or diagnosis, furnished in the least intensive setting required, and in compliance with the standards of good medical practice. Therefore, the correct answer is D, all of the above.

Most Health Plan Contracts Provide an Outline of the Criteria