Insurers rely on doctors whose judgments have been criticized by courts
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Re: Insurers rely on doctors whose judgments have been criticized by courts
#2This seems like a good spot to start with policy changes:
> In interviews with ProPublica, federal judges criticized a system that fails to address problems that arise in court case after court case. They faulted the Employee Retirement Income Security Act, which governs many insurance claims in court, for not allowing for punitive damages, the sort that can rise into the millions of dollars and deter companies from bad conduct.
> To one federal judge, who like others spoke about cases on condition of anonymity, doctors and the insurance companies they work for essentially get off scot-free. “They might have to pay 10 claims,” the judge said, “but if they can avoid paying a thousand claims, then why would they change anything?”
Re: Insurers rely on doctors whose judgments have been criticized by courts
#3These "doctors" should be barred from practicing medicine. I am not a lawyer, but it would seem that this practice also borders on criminal negligence.
Re: Insurers rely on doctors whose judgments have been criticized by courts
#4This seems like a good spot to start with policy changes: > In interviews with ProPublica, federal judges criticized a system that fails to address problems that arise in court case after court case. They faulted the Employee Retirement Income Security Act, which governs many insurance claims in court, for not allowing for punitive damages, the sort that can rise into the millions of dollars and deter companies from…
Fraud is the business model and it pays extremely well
Re: Insurers rely on doctors whose judgments have been criticized by courts
#5These "doctors" should be barred from practicing medicine. I am not a lawyer, but it would seem that this practice also borders on criminal negligence.
Oddly, it's not currently considered to be.
> Having the weight of an MD behind a decision can be powerful, but lawyers and judges who’ve handled these sorts of cases say it can be misleading. Although doctors ultimately determine whether to cut off insurance coverage for a particular treatment, those decisions are generally not considered the practice of medicine and therefore cannot be challenged in a malpractice lawsuit. The doctors advising insurance companies can’t be individually sued on medical grounds, even if something goes wrong after the denial. As a result, their names are cited in lawsuits filed against the insurers, but they are not defendants in suits brought by people denied insurance.
Re: Insurers rely on doctors whose judgments have been criticized by courts
#6More light needs to be brought to this, and serious action needs to be taken on behalf of insurance policy holders, NOT on the behalf of shareholders of "insurance" corporations.
Well done, Propublica. Keep it coming!
Re: Insurers rely on doctors whose judgments have been criticized by courts
#7This seems like a good spot to start with policy changes: > In interviews with ProPublica, federal judges criticized a system that fails to address problems that arise in court case after court case. They faulted the Employee Retirement Income Security Act, which governs many insurance claims in court, for not allowing for punitive damages, the sort that can rise into the millions of dollars and deter companies from…
Fraud is the business model and it pays extremely well
Whatever happened to Primum non nocere.
Re: Insurers rely on doctors whose judgments have been criticized by courts
#8This seems like a good spot to start with policy changes: > In interviews with ProPublica, federal judges criticized a system that fails to address problems that arise in court case after court case. They faulted the Employee Retirement Income Security Act, which governs many insurance claims in court, for not allowing for punitive damages, the sort that can rise into the millions of dollars and deter companies from…
Fraud is the business model and it pays extremely well
Reminds me of a joke i once heard: a regulator walks into an insurance corporate office and exclaims "wait a second, you're supposed to be running a racket! instead, you're committing fraud!" while in a parallel universe, the same regulator walks into the same office and exclaims "wait a second, you're supposed to be committing fraud! instead, you're running a racket!". the regulator then slams his head against the wall, and realizes that there is no parallel universe - that insurance corporation is indeed blatantly running a racket AND committing fraud on a massive scale.
RICO charges need to hit, and stick.
Re: Insurers rely on doctors whose judgments have been criticized by courts
#9Re: Insurers rely on doctors whose judgments have been criticized by courts
#10These "doctors" should be barred from practicing medicine. I am not a lawyer, but it would seem that this practice also borders on criminal negligence.
Oddly, it's not currently considered to be. > Having the weight of an MD behind a decision can be powerful, but lawyers and judges who’ve handled these sorts of cases say it can be misleading. Although doctors ultimately determine whether to cut off insurance coverage for a particular treatment, those decisions are generally not considered the practice of medicine and therefore cannot be challenged in a malpractice l…
> Oddly, it's not currently considered to be.
Odd indeed. Is it some semantic thing? Denying care is the purest form of not practicing medicine?