# Medical Necessity: How Payers Decide What They Cover

Canonical: https://www.flobotics.io/blog/medical-necessity-explanation
Author: Bart Teodorczuk
Published: 2026-03-30
Updated: 2026-09-01

---

[Home](https://www.flobotics.io/)/[Articles](https://www.flobotics.io/blog)/Medical Necessity: How Payers Decide What They Cover

[Healthcare](https://www.flobotics.io/blog?category=healthcare)[RCM](https://www.flobotics.io/blog?category=rcm)

# Medical Necessity: How Payers Decide What They Cover

[Bart TeodorczukHead of AI at Flobotics](https://www.flobotics.io/our-editorial-team#teodorczuk)
Published March 30, 2026Updated September 1, 2026

Book a callWant to talk about it?
30 minutes with someone who builds automations, not a sales script.
[Book a 30-minute call →](https://www.flobotics.io/book)

Share
[](#)[](#)

## Medical Necessity

The determination that a health service is essential for diagnosis or treatment based on professional standards, which dictates payer coverage.

Let’s talk!
It’s a 30-minute call. Within the first 15, we’ll know if automation works for you.

[Book a 30-minute call →](https://www.flobotics.io/book)

Written byBart Teodorczuk
Head of AI at Flobotics. [More from Bart](https://www.flobotics.io/our-editorial-team#teodorczuk)

Talk to us

## Show us the process your team is tired of doing manually.

Let Karl, our CTO, or Bart, our Head of AI, take a look. It’s 30 minutes with someone who designs the automations, not a sales script.

[Book a 30-minute call →](https://www.flobotics.io/book)[Send a message](https://www.flobotics.io/contact#contact-form)

30-minute callKarl or BartOur CTO, or our Head of AI

Walk us through the process your team does by hand. We’ll tell you whether it’s worth automating and how we’d approach it.

Karl & Bart

Keep reading

## More insight

The latest industry news, interviews, technologies, and resources.

[

HealthcareRCM

### What Is Prior Authorization (Pre-Auth) in Healthcare?

Prior authorization (pre-auth), explained: the process behind healthcare's 13-hour weekly physician burden - and how automation cuts each cycle to minutes.

Bart TeodorczukApril 30, 2026

](https://www.flobotics.io/blog/prior-authorization-pre-auth-explanation)[

EligibilityHealthcareRCM

### Insurance Eligibility Verification in Healthcare, Explained

Eligibility verification guide: confirming insurance coverage and patient financial responsibility before the visit, in real time.

Krzysztof SzwedApril 08, 2026

](https://www.flobotics.io/blog/eligibility-verification-explanation)[

HealthcareRCM

### Clinical Documentation Integrity (CDI): Why It Matters

Clinical Documentation Integrity (CDI), explained: how documentation gaps drive undercoding and silent revenue leakage.

Karl MielnickiMarch 03, 2026

](https://www.flobotics.io/blog/clinical-documentation-integrity-cdi-explanation)

[All articles →](https://www.flobotics.io/blog)