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What Is a “Medical Necessity”?

The concept of “medical necessity” is important when considering medical transport services and whether or not your insurance company will cover the costs. The concept of “medical necessity” is the standard that is used to judge whether most medical situations will qualify for insurance coverage or not.  As such, patients and loved ones who are hoping that insurance will cover the cost of commercial air ambulance services or other types of medical transport need to be aware of the definition of medical necessity and think carefully about how it relates to their current situation as part of their decision-making process.

Medical necessity is defined roughly as any form of health care that a qualified and experienced physician would provide to a patient. This can include prevention, diagnosis, and illness, injury, or disease prevention. Symptomatic relief of pain or discomfort is also considered a medical necessity in some situations. Basically, if most physicians would recommend a particular course of treatment or a set of actions related to a positive medical outcome, then the treatment or course of action would be considered “medically necessary” by most insurance providers.
See: http://www.airambulance.net/air-ambulance-medicare
Transport by a commercial air ambulance is often covered by insurance as long as the service is not being used merely for the patient’s convenience. As long as the transportation is necessary in order to obtain positive outcomes for the health of the patient, it should be covered by insurance, however, there are no guarantees. Flight coordinators will act as a liaison with insurance companies on the patient’s behalf in emergency situations to determine whether or not the fees for an air ambulance transfer or evacuation will be covered. Contact your insurance provider to discuss coverage for long-distance ambulance transfers, medical escorts, or other types of medically supervised transfers via ambulance.