3 ms·

I guess, but if so, that's a massive amount of cost to the insurer (and eventually falls back on the consumer) around paperwork/review/approval for something th

I guess, but if so, that's a massive amount of cost to the insurer (and eventually falls back on the consumer) around paperwork/review/approval for something they're going to approve eventually. I really don't understand it. Certainly in my experience, the insurer could get rid of their internal review process and people, just rubber-stamp whatever our MDs are prescribing, and save us all a lot of money and headache.

lotsofpulp 6y ago
>the insurer could get rid of their internal review process and people, just rubber-stamp whatever our MDs are prescribing, and save us all a lot of money and headache. If that was true, there would be an insurer doing that and offering lower premiums on healthcare.gov But it's not true, and the review processes do control costs (even if wrongly at times). I think the government farms this task out to insurers specifically so the insurer can take the heat for the denials, when it's actually the government's rules and standards for the requested therapies that is resulting in denial of coverage. I've personally seen this with Medicaid or CMS penalizing for erroneously approving payment for treatments and also erroneously denying payment for treatments. And it gets very fun when the rules are not clear and there is a lot of gray area.