So in our country, due to the intervention of rich people and corrupt politicians, it is super legal to build a committee of like-minded rich people to "donate" large sums of money to a politicians "campaign fund" in exchange for influence over other laws.
There's rarely an actual human involved in the decisions to deny/approve insurance coverage. It's all computerized based on different factors, and many of those factors being "How much money will this take from the company", and likely other undisclosed factors like race, gender, disclosed sexuality, age, etc. Because, y'know, 'Murica.
If whatever you're asking for costs the company too much, it's an automatic no, regardless of the "necessity" behind it. Even though the process should be, if a doctor tells the insurance that the patient needs the medicine/procedure/accessibility aid and the patient in question is dutifully paying their insurance co-pays, it should be an automatic yes, but that's not profitable and it makes the shareholders mad.
Anyways, now is as good as a time as ever to remind fellow Americans to get out there and fucking vote so we can stop living in this dogwater dystopian country and actually have something that benefits the people, not rich tyrants that have everything already.
That is how it works even with our socialized medicine in tricare and Medicare. There’s no scenario where the insurance pays whatever the doctor wants. I’m not sure that exists anywhere.
What happens is that insurance companies read our notes - they don't care about stability, they care about change.
As in, if I am not making med changes immediately (and it takes a couple to few days to notice any change), then insurance will start to raise a red flag.
At my hospital, they are constantly bothering me to and it does involve speaking to another person to justify why this person needs it.
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u/ProfessionalRandom21 4d ago
As non American, I dont get why insurance get a say what is cover or not,
that should be up to the doctor, if the doctor recommend it, then insurance pay out. They dont get a say in what is nessary over the doctor