Medical Expense✓ Verified · outline & fact-checked · Sep 2026Difficulty 1/5
Most major medical policies limit payment to services that are 'medically necessary.' This means the service must be:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The medical necessity requirement ties coverage to services that are consistent with generally accepted standards of medical practice and are required for the diagnosis or treatment of an injury or illness. Services that are experimental, elective, cosmetic, or beyond the level of care appropriate to the condition may be denied as not medically necessary. This standard underpins most coverage decisions under major medical plans and is a defining limitation of the coverage.
Why the other options are wrong
- B) The insured's request alone does not make a service medically necessary; the treating provider's judgment under accepted standards governs.
- C) Many medically necessary services — office visits, laboratory tests, physical therapy — are provided outside a hospital.
- D) Cost is not the test; a medically necessary service is covered even when a more expensive alternative is chosen, subject to plan design.
Memory hook
Medical necessity = care that meets accepted standards and actually treats the condition.