They do employ medical doctors to review cases, give prior authorization for specific treatments and diagnostic tests, etc. There can also be doctor to doctor c

They do employ medical doctors to review cases, give prior authorization for specific treatments and diagnostic tests, etc. There can also be doctor to doctor calls to explain why a particular item was justified. The thought of some random doctor reviewing your file and the notes generated from a visit and making a determination having never seen you sucks. It's been passed ok'd as "ensuring doctors are following the best practices and ensuring consistent standards of care", which it may to an extent. As with most aspects of US healthcare, when viewed through through the perspective of the recipient, it's atrocious. Every medical facility requires you to sign a paper that you'll pay all the medical expenses if they aren't covered by insurance. They can't give you an estimate that they promise they'll stick to in terms of cost. There's no way a non-doctor could know what the typical course of treatment would be, so they're stuck trying to get straight answers from an insurance company if they don't want a surprise massive bill. Provider bills insurance an insane amount which is then arbitrarily discounted. Provider can't bill different amounts for insured or uninsured patients (illegal from my understanding). If insurance doesn't cover something, it's between the patient and provider to settle.