Many years ago, I was asked to be a contract medical director for a bunch of health insurance companies to “review claims.” What I saw shocked me:
— Houman David Hemmati, MD, PhD (@houmanhemmati) May 28, 2024
Along with the patient records, they’d send me their “Medical Policy” documents for each disease which were rigged to almost always… https://t.co/BrTnW9RRR6
Many years ago, I was asked to be a contract medical director for a bunch of health insurance companies to “review claims.” What I saw shocked me:
Along with the patient records, they’d send me their “Medical Policy” documents for each disease which were rigged to almost always deny claims, and they included a statement that I could NOT reference any “outside literature” aside from their own rigged Medical Policy document.
After a week of doing this very part time, I told them I’m quitting and tried to notify Congress. It fell on deaf ears. That’s when I realized this whole system is designed to scam patients: Pay an obscene amount of money to get “insurance” which is then allowed to arbitrarily deny claims based NOT on medical fact but rather their own “policy” documents written by MBAs and lawyers, not practicing doctors.
This badly needs to change. Medical claims decisions must be truly independent, based on the total clinical evidence, and in no way rigged in the insurance company’s financial interest.
Regular people don’t have the means to fight them and the in. So they give up.
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