Something that would smooth things over for the patient and physicians in the health insurance world would be if health insurance companies had medical liability for treatments that they needed to pay for.
Courts have ruled that they don’t, even when they cause harm to a patient.
No liability, zero.
In essence they argue that there is no doctor patient relationship established, and they are not saying that the patient can’t get the treatment, just that they won’t pay for it.
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In the actual world, health insurance companies not wanting to pay for a treatment really means that the patient won’t be able to get it.
I often bemoan their process for MSK issues, such as ordering an MRI, but they even do this to oncologists.
Can you imagine your oncologist recommending a treatment so you don’t die from cancer, and your health insurance company decides that it’s not worth paying for?
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If a health insurance company contracts with a physician, then they should approve the treatment that the physician recommends. And if they don’t, they should have medical liability for poor outcomes, just like the physician does.
Remember that they are making their denial recommendations without ever having examined the patient.
If a doctor did this they would lose their medical license.
