Having the insurance company deny treatment, medication or another order from your Washington doctor is very frustrating. After all, if your doctor says you need a specific test, treatment or medication, then you would trust that he or she knows what is best over some insurance worker who denies the claim. You may wonder why insurance companies can deny claims that come directly from doctor’s orders.
While your doctor is looking out for what is best for your health, Verywell explains that the insurance company is focusing on the cost. When the insurance company makes a decision, it is not taking into consideration whether this is the best course of action to treat your condition. It is looking at whether this is the cheapest way to do it. If there is an alternative option that other doctors use that will cost the insurer less money, then it will deny your claim.
This is true even if whatever you need is a covered service or item. If the insurer finds a cheaper way to do it within the recognized standards of care, then it will want you to do that instead, regardless of your doctor’s medical opinion or your personal situation.
The key here really is that the insurer is watching out for its bottom line. It wants to earn more money than it pays out, and to do that, it needs to deny as many high-cost items as possible. On the other hand, your doctor is not usually looking at costs but rather what will offer you the best treatment.
This is a situation that is frustrating and upsetting because you want the best healthcare but your insurer is holding you back from getting it. This information is for education and is not legal advice.