If I, as a medical professional, see a patient and violate the accepted standards of care, leading to harm, I have committed medical malpractice.
This makes me legally liable for the patient’s injuries, and I can be sued for damages.
However, this same standard does not apply to health insurance companies.
When a health insurance company denies a patient access to necessary medical care, even if it has been prescribed by a physician who has seen and assessed the patient directly, the company faces no such liability.
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If the patient suffers harm as a result of this denial, the insurance company cannot be sued for malpractice.
Why?
Because there is no established “doctor-patient” relationship between the health insurance company and the patient, absolving the company of legal responsibility.
This lack of accountability is alarming.
While I may express frustration over musculoskeletal (MSK) issues and insurance denials related to them, the problem goes deeper.
The insurance company cannot be sued for malpractice because there is no established "doctor-patient" relationship between the health insurance company and the patient, absolving the company of legal responsibility.
Health insurance companies are also denying coverage for essential, even life-saving treatments, such as those related to cancer care.
Yet, despite these potentially devastating decisions, they continue to face zero liability.
This is ridiculous.
The idea that a health insurance company can interfere in the care of my patients—or in anyone’s care—without facing any consequences for harm caused, is deeply troubling.
I, for one, do not want insurance companies determining the course of my patients’ treatments.
