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What is Medically Necessary in International Private Medical Insurance?

Understanding Medically Necessary in IPMI: What is Covered and What is Not

In the context of IPMI (International Private Medical Insurance), “medically necessary” refers to a term used to describe medical treatments, procedures, or services that are deemed to be required for the diagnosis, treatment, or management of a medical condition. These treatments, procedures, or services are considered to be essential to maintain the health of the policyholder and are covered by their insurance policy.

What is deemed to be “medically necessary” can vary between insurance policies and countries, but generally includes treatments, procedures, or services that are necessary to diagnose, treat, or manage a medical condition, and which are provided in a safe, effective, and evidence-based manner. For example, inpatient hospitalization for a surgical procedure, diagnostic imaging such as an MRI, or a prescription for a medication to manage a chronic condition would generally be considered medically necessary.

On the other hand, treatments, procedures, or services that are not deemed to be medically necessary may not be covered by the policyholder’s insurance. For example, cosmetic procedures such as elective surgery, dental procedures such as teeth whitening, or alternative therapies such as acupuncture may not be considered medically necessary and therefore may not be covered by the insurance policy.

It is important to note that the determination of what is and is not medically necessary is made on a case-by-case basis and may depend on the specific circumstances of the policyholder’s medical condition and the country in which they are located. Policyholders should consult with their insurance provider to determine what is covered under their policy.