If stuff like voluntary plastic surgery wasn't covered, what the hell kind of medical fraud would there be?
We have OTHER systems to find doctors prescribing drugs, so wtf does insurance provide the consumer except a pathway to debt?
We have OTHER systems to find doctors prescribing drugs, so wtf does insurance provide the consumer except a pathway to debt?
Off the top of my head: going to a doctor, conspiring with him to make an insurance claim that you had some sort of procedure done even though none was actually done, and splitting the claim check? Not saying this happens, but it's not hard to think of frauds you could perform even if "voluntary plastic surgery wasn't covered".
Or a doctor prescribing a monthly massage to a patient. Or approving a questionable disability claim. etc. etc.
Fraud finds a way to happen.
...until the patient looks at his health insurance account and notices a charge that he doesn't recognize, or the insurance company decides to do a random audit of a claim.
I don’t mean to overstate the argument. Claim denials are a terrible way to resolve disputes like this, because they inflict quite a lot of pain and stress on the helpless patient who did nothing to cause it and can’t meaningfully help resolve it. But it’s important to understand why simply telling insurance companies to stop denying claims, despite its intuitive appeal, isn’t a real option.