That’s nitpicking. Is it medically necessary to support someone in a coma that likely won’t have a good outcome? It’s always about the money with insurance. That has to be assumed.
It’s not nitpicking, it was the literal denial reason. You are explaining why you think it was okay for them to do, but that’s not the reason given for a denial. They need to be able to defend what their denial actually says, not what you think it means, in the event of a lawsuit or appeal.
“Medically necessary” has a legal meaning, and it’s not dependent on whether you consider them a ‘useless eater.’
Medically unnecessary = we don’t support the decision making and don’t want to pay for it. It’s the only language they will ever use. This is just the wording insurance companies use to deny claims.
Medically necessarily to have a chance to live, YES. You are confusing medically necessary with profitable, which is the whole point behind the outrage and the reason why the insurance “industry” is monstrous and dispicable.
I get what you’re saying. Every denial reason is just a code for this is too expensive. The reason itself might be grounds to argue, but they are just going to try to deny it again with a different reason code.
To your original point, I agree that we should ask ourselves if it’s worth hundreds of thousands of dollars just to keep a vegetable breathing for a few more days. Frankly if I were in that shape, I know death would be a kindness.
But I will say it seems immoral to leave the decision in the hands of the profit-makers.
That’s nitpicking. Is it medically necessary to support someone in a coma that likely won’t have a good outcome? It’s always about the money with insurance. That has to be assumed.
It’s not nitpicking, it was the literal denial reason. You are explaining why you think it was okay for them to do, but that’s not the reason given for a denial. They need to be able to defend what their denial actually says, not what you think it means, in the event of a lawsuit or appeal.
“Medically necessary” has a legal meaning, and it’s not dependent on whether you consider them a ‘useless eater.’
Medically unnecessary = we don’t support the decision making and don’t want to pay for it. It’s the only language they will ever use. This is just the wording insurance companies use to deny claims.
Medically necessarily to have a chance to live, YES. You are confusing medically necessary with profitable, which is the whole point behind the outrage and the reason why the insurance “industry” is monstrous and dispicable.
I get what you’re saying. Every denial reason is just a code for this is too expensive. The reason itself might be grounds to argue, but they are just going to try to deny it again with a different reason code.
To your original point, I agree that we should ask ourselves if it’s worth hundreds of thousands of dollars just to keep a vegetable breathing for a few more days. Frankly if I were in that shape, I know death would be a kindness.
But I will say it seems immoral to leave the decision in the hands of the profit-makers.
I’ll go with the opinion of the patient’s doctor, rather than some internet rando, thank you very much
The patient’s doctor isn’t the one that denied it. I’m not really sure what you’re saying. I think you just agreed with me.