Doctors working for health insurers can rule on 10,000 or more requests for care a year. At least a dozen were hired by major insurance companies after being disciplined by state medical boards or making multiple or outsized malpractice payments.
Doctors working for health insurers can rule on 10,000 or more requests for care a year. At least a dozen were hired by major insurance companies after being disciplined by state medical boards or making multiple or outsized malpractice payments.
It really does though. Medicine is far too siloed and far more specialized now days than most people realize. This makes it nearly impossible for someone to really be able to determine medical necessity outside of their specialty. I would never trust a surgeon on endocrine issues or an emergency physician on primary care. The skill set and knowledge is just so wildly different.
There is a reason physicians are trying to get laws passed that would require peer to peers be conducted by people in the same specialty.