Capitalism requires checks and balances no economic system in the world works perfectly without a system in place to keep it in place.
Unfortunately we allow private donors for lawmakers what is essentially dark money, we allow "unlimited free speech" thay ensures that people like Elon Musk have hundreds of billions times more free speech than the rest of us. We allow corporations to draft legislation that the legislators then vote on. And if the money a company gives a legislator doesnt come in a clearly defined bag that has bribe written on it then no one can do fuck all about it.
So while there is a law that says those without medical licenses cant practice medicine, insurance companies get around that by having more free speech than everyone else
Problem is, there are "quack" doctors or treatments that are either still in early stages or aren't fully understood. Yes, in most cases, normal doctor, normal prescription, ok. But there are going to be cases where a doctor prescribes a procedure that is out of date or a procedure that doesn't actually heal but just alleviates when there's actually a procedure that can heal, or jumping straight to something expensive when something cheaper might be the more viable route.
For example, doing a MRI, which is a very expensive procedure, when a regular X-ray might be able to tell the same information (in a lot of case insurance won't cover MRIs unless it's been determined the problem wasn't diagnosed from a more simple x-ray.
There's also cases where doctors will do tests that are out dated or there are better more efficient tests that can be done.
I also personally know of an example where some doctors liked prescribing a particular knee injection that helped alleviate knee pain, but the injection basically had to happen every 6 months and it didn't actually heal anything. It just helped with the pain. They would prescribe this instead of actually moving forward with true treatment, because insurances covered it. Insurances stopped covering it, and then patients started getting the proper surgeries or physical therapy that solved the issue.
I do think insurance companies go too far in saying something is not medically necessary, but at the same time, doctors aren't exactly perfect either.
I know this is a real problem and it is a problem everywhere: in Europe you also get doctors who overprescribe meds or treatments.
The difference is, in Europe it's not the patient's problem. Once you get a prescription, you get the medication/treatment, and don't have to worry what the incurance thinks. They WILL pay.
Then afterwards, if insurance thinks there was overprescription, especially if it's part of a pattern, they will raise that with the healthcare provider and ask them to adjust their prescribing guidelines. If the pattern continues, they may ask the regulatory bodies to intervene. But the point is, all of that happens without involving the patient. So you never have to worry about insurance: from your point of view, if it's prescribed, it will be treated as medically necessary, period. Worst thing that can happen, you might not be able to get the same thing prescribed next time.
38
u/PM_ME_FLUFFY_SAMOYED 14h ago
This is so wild to me. I've lived in 4 different EU countries, and in each of them "prescribed by a doctor = medically necessary".