Medically necessary means the health care is needed to prevent, evaluate, diagnose or treat an illness, injury, symptoms or disease you might have. The treatment must also meet the following criteria:
- Provided in accordance with generally accepted standard of medical practice (not regarded as experimental by your health care company)
- Clinically appropriate in terms of type, frequency, extent, site and duration, and considered effective for your illness, injury or disease
- Not primarily for you or your provider's convenience
- Not more costly than an alternative service or group of services
Blue Cross Blue Shield of Michigan and Blue Care Network determine what is medically necessary under your plan.