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Practice Management:

Read the Fine Print on Payer Policies for Medical Necessity

Published on Fri Oct 25, 2024

Question: Isn’t preventive care implicitly medically necessary? Massachusetts Subscriber Answer: Most payers probably aren’t interested in philosophical discussions about the type of care they’ll cover, and they have reams of policies down on paper so providers, patients, and any other stakeholders can find answers. Cigna, for example, says: “Preventive care may be Medically Necessary, but coverage for Medically Necessary preventive [...]
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