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The policies consist largely of guidelines regarding what the most cost-effective treatment option for a condition is likely to be. Good insurance companies do
by SpicyLemonZest 2y ago
The policies consist largely of guidelines regarding what the most cost-effective treatment option for a condition is likely to be. Good insurance companies do try and discuss with providers rather than firing off denial letters willy-nilly, but of course that still ends up being a conflict where your insurance might not let you have the treatment your doctor thinks is best.
This conflict is why I've always subscribed to Kaiser when I have the option. It's much less headache for me if there's no distinction between what a doctor wants to prescribe me and what they're allowed to prescribe. (Would I feel differently if I needed some crazy custom treatment protocol? Perhaps.)
- lijok 2y agoThat sounds very strange to me. If the adjuster has this information, why the need for a review from a consulting doctor? And why would the consulting doctor not be expected to know the costs of these treatment options, at least in relation to alternative options?
- SpicyLemonZest 2y agoIn most states (I think all?) insurance companies are required by law to get review from a consulting doctor if they're going to challenge a claim. I don't really think we could expect a doctor to know offhand the relative costs of every treatment for every potential condition in their specialty.