Are communication services typically considered medically or educationally necessary?
Communication services can qualify as either or both. It depends on an individual’s circumstances and the availability of potential funding sources. Educational necessity is usually claimed when access to communication services and supports enables an individual to participate in and benefit from public education. Medical necessity is claimed when the communication limitation arises from a diagnosed condition. In many cases, both standards apply. However, insurance companies have no obligation to pay for services/devices that are educationally necessary; their only responsibility is for services that are medically necessary. Public schools, on the other hands, must pay for services deemed by the special education team to be educationally necessary, regardless of whether they also meet the medical necessity standard.
Related Questions
- I understand the discount applies to uninsured patients for medically necessary health care services. What exactly does that mean?
- Do HMO or HMOPOS plans cover services that Medicare does not consider medically necessary?
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