Yeah, no, fuck off with that. The doctor is the care provider, not the insurance company, and an insurance company has no fucking business deciding what is or isn’t medically necessary.
I notice how you didn’t actually address my point all, just reiterated the claim.
I don’t believe this happens that often, but what happens in the case that a doctor prescribes completely unnecessary procedures and visits, which makes them rich. Still the insurance company shouldn’t do anything?
If your wife has not seen or treated the patient, she has no basis to deny the claim as medically unnecessary. She has no idea what conditions the patient may have that would necessitate having a different seat cover. I get that you love your wife, but her job leads to significantly more pain than benefit.
she has no basis
You’re just wrong. I assume it because you have no medical experience and don’t have any knowledge of how any of this works, but doctors are supposed to take good notes throughout their care that go into charts. This is done so any doctor, especially if we are talking about in a hospital, can step in and read what has been done, why it was done, so they know what they should do next. There are also standards of care for certain conditions that have been established and reviewed by many other doctors.
So she can absolutely read these charts and the standards of care and have a very good basis for what is and what is not necessary. Is it 100%? Of course not, which is why doctors and patients can appeal. But if they can’t justify why it is medically necessary, which was certainly the case here and it was clearly just a case of quality of life, then it makes sense not to waste resources…this would be true with or without private medical insurance.
Insurance companies shouldn’t exist. Healthcare should not be a for-profit institution.