(08-03-2019 11:00 AM)Fountains of Wayne Graham Wrote:  

(08-02-2019 05:11 PM)OptimisticOwl Wrote:  

(08-02-2019 04:24 PM)RiceLad15 Wrote:  Are there not cases where a doctor prescribes a specific treatment and someone's insurance doesn't cover that treatment?

Of course, but whether or not it is covered is in the contract, and NOT a decision made on a case by case basis.

You guys act as though insurance companies have some special board that meets tp degide if they will cover this or that today. The Chairman asks "How do we feel today about colonoscopies? The board choruses "They are a pain in the ass! Deny them all, except for my brother in law."

Nothing shows ignorance more than thinking insurance companies decide what to pay for.

I wish many of you would be more generous in your reading of comments by those you perceive as the political enemy instead of ending every post with "your ignorance or bias is showing."

Anyway, perhaps this is a semantic disagreement. Yes, one signed a contract with an insurance company about what is and is not covered, but the interpretation and dispersal of those benefits by a claims department requires judgement. And that judgement is absolutely influenced by the company's bottom line.

As for the bolded, not in the modern medical practice for the most part (i.e. 98%+). This is absolutely for massive part as close to a ministerial function as opposed to a discretionary one, that you seemingly make the case for.

If you are wanting to believe that the outcome of the plain, mundane portions for the vast majority of claims are driven by a 'bottom line' intent, you are more than free to do so.

You would be correct that pretty much all the issues one hears about in the news are de rigeuer for the industry; they are not. Think about how you heard about them, then think to yourself about what makes great news, and what makes great examples to beat an opposition up with moralistically. They aren't the 99.9 per cent that are disposed of regularly --- they are by far the outliers; i.e. the definition of 'good news stories' and 'great stories to beat up the opposing viewpoint with'.

If you really think that vast, vast, vast majority of monies and claims are not disposed of regularly --- as your post seems to provide a basis for -- I would say you are horribly mistaken.

So tell me, which is more likely to occur --- a) the insurance company pay the coded treatment for a broken arm; or b) the insurance company provides written instructions to every single disbursement requiring a thorough review and a kick back and refusal of benefits based on 'stretched' interpretations; resulting in a .05% change in the bottom line.

One is legal and hassle free; one almost requires the company violate civil conspiracy and racketeering laws, in addition to the consumer protection laws of every state covered by the contract, and review by the FTC.

Hate to tell you, the insurance companies tried that in the late 80's to mid 90's. I would surmise they learned some very expensive lessons in the process via the legal system.

Sorry, I just dont buy that massive assumption you put out there.