jamesgelliott t1_jdzokfa wrote on March 28, 2023 at 11:21 AM

Reply to comment by haspfoot in ELI5: Why are health insurance companies in the US allowed to deny coverage for doctor-approved medical care? by adamzam

It's not inappropriate treatment. You can't expect every MD, Nurse practitioner and Physician's assistant to know every clinical pathway for every insurance provider.

Recently I had a colonoscopy. The MD ordered a prep that wasn't covered by my insurance but it did cover an older less expensive option. The pharmacy simply had to contact the MD and get the order changed.

haspfoot t1_jdzovcx wrote on March 28, 2023 at 11:24 AM

Well, if providers can't be expected to know, then certainly the burden shouldn't be shifted onto the patient. Ideally the whole thing would be overhauled with a focus on medical outcomes and not profits.