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Regarding the purpose of 'good health', public hospitals have to admit anyone in need of medical care, have to treat a patient as long as medically necessary and have to decide on the medical treatment based on medical grounds solely.
The phenomenon of Canadian patients privately choosing to travel outside of their home health system to access medical care abroad is intriguing, as medically necessary health care in Canada is publicly funded and universal.
A contact was scored as medically necessary if the GPs believed, based on their own medical view, that it was necessary to contact a GP during out-of-office hours.
Similarly, with procedures, if I cannot justify the procedure as medically necessary to a patient's insurer, I won't be paid.
The potential significance of letting doctors define specific drugs as "medically necessary" is illustrated by Oregon's Medicaid program for its poor and disabled residents.
A spokeswoman for the state Health Department said that generally, Medicaid will cover 24-hour care if it has been ordered by a doctor as medically necessary.
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His insurance company denied the request as "not medically necessary". Six weeks of comatose and/or heavily medicated hospitalization followed before the ultimate realization that William was consigned to a persistent vegetative state.
If her claim is based on needing it outside her home, it will be denied as not medically necessary, because the wheelchair or scooter will be considered as a leisure item.
"Now my wife and I are waging our own fight with the provider to arrange payment for my daily brain radiation, which has been rejected as 'not medically necessary' even though the cancer in my brain is growing rapidly". "For me and other Americans suffering from advanced cancer," he concluded, "the health-care debate this summer is no abstraction.
The truth of what is now happening in this country is that diagnostic tests and certain treatment protocols are being "denied" by insurance companies as "not medically necessary".
The decision appears to support the right of the states to let patients hold a health plan accountable when it wrongly denies care that was medically necessary, as long as the care was within the coverage of the health plan.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com