Where should the line be...

[radcen]

Where should the line be between what one's personal doctor prescribes and what insurance pays for?

For example: A doctor prescribes Medicine A as a prescription. Insurance company says either get a pre-authorization for Medicine A or pick another medicine. When the doctor attempts to get said pre-authorization, doctor is refused (makes a person question how valid the "choice" really was to begin with).

There is nothing in the contract or coverage document that says Medicine A was not covered, it's just the insurance company not wanting to pony up for an expensive brand name drug where no generic option is yet allowed on the market.

The insurance company is in business to make a profit, of course, but the insurance company didn't have their doctor in the examining room and hence is clueless regarding the patient's real-life medical needs. The patient's doctor, meanwhile, was in the room and made an educated decision regarding what the patient needed based on interacting with the patient.

 

[274ina]

Eliminate the Dr and the Insurance corp.

Replace with a Dr on salary that makes decisions based only on Medical need.

Simple. That is why all other western nations do it this way.

 

[Sarcogito]

Wherever the line is drawn, the person doing the drawing should be an MD.