Health Care & Hospital Law
Jul. 6, 2011
Doctors Should Determine Medical Necessity, Not Insurance Companies
Health insurers have too long ignored California's longstanding medical necessity standard. By William M. Shernoff and Samuel Bruchey of Shernoff Bidart Echeverria
For many years, health insurers have carried out a disturbing practice of systematically overruling the judgment of physicians when they investigate the medical necessity of treatment provided to policyholders.
To do this, they create self-serving policy definitions of "medical necessity," and deny claims when treatment does not fit within these terms. These insurers deny claims as not medically neces...
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