New drugs and treatments

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Why did my health plan say a drug or service isn’t medically necessary?

Sometimes doctors prescribe or recommend drugs and services that:

  • May not be your best option
  • Haven’t been carefully studied and proven to be safe and effective

When that happens, your health plan may say the medicine or service isn’t medically necessary. They may recommend a different drug or service that’s usually a safer and/or more effective option.

If you choose to use the medicine or service recommended by your health care provider you will have to pay for it yourself – unless your health plan can be convinced to cover it.

Contact OHA for help getting a recommended drug or service covered by your insurer.

Claims and Denials