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Explain to me what you mean by "supported by evidence?" Is it some kind of cost-benefit analysis? Because if so that's certainly denying a claim on the basis of
by jschwartzi 6y ago
Explain to me what you mean by "supported by evidence?" Is it some kind of cost-benefit analysis? Because if so that's certainly denying a claim on the basis of saving money.
- lotsofpulp 6y agoSupported by science experiments conducted by scientists showing efficacy or causation. It is doctors and pharmacists that deny and approve, and they don’t have information about how much the company is saving if they deny. The most common denial reason is for doctors ordering brand name drugs that cost 10x more than a generic, but have no data to show they are any better. Or drugs that aren’t shown to have any effect, but doctors just want to appease the patient or experiment.
- reificator 6y ago> The most common denial reason is for doctors ordering brand name drugs that cost 10x more than a generic, but have no data to show they are any better. Or drugs that aren’t shown to have any effect, but doctors just want to appease the patient or experiment. My diabetic friend has documented bad reactions to the expensive name brand insulin and a couple of others, but not a specific cheap (relatively speaking) one. His insurance mandates that he use the name brand exclusively and will categorically deny any other form of insulin. Now, maybe this doctor is just prescribing insulin to a fucking diabetic to appease the patient, but for some reason I doubt that's the case.
- FireBeyond 6y ago> and they don’t have information about how much the company is saving if they deny. Any denial, is prima facie, going to save money versus paying any claim.
- lotsofpulp 6y agoNot if it causes them to spend more on costlier healthcare in the future.