My husband is a sole proprietor Physician/surgeon. Not Medicare but private insurers are now starting to deny any medical treatment or surgical procedures "experimental", on a whim. Treatment that has been accepted as the norm for years and covered by Medicare. They don't have to provide a reason and there is no way for insureds or doctors to dispute their decisions which are against the norm. So heads up people your insurance can be worthless when you need it most because the PPACA did not to protect you from this. So much for transparency when you are shopping insurance plans both on the exchange or privately.
There is no list as only the insurance companies have the list. Which we don't get nor do the insureds. For, best to ask for a response from people whose insurance has denied payment for their treatment. Do you have proof this isn't happening? You think I am lying about such an important topic?
There is a local practice that used to do a lot of laser/surgical procedures for leg pain that completely stopped that area of practice. They ran an ad in the paper explaining that they were doing it because insurance companies were no longer covering the procedures. A lot of factory worker types used to go to them because of perpetual swelling in their legs, getting veins removed, etc. I know one person who got caught up in it. They had one leg done and the company insurance suddenly stopped covering it so they could not get the other leg done. Have no idea what the technical procedure was, but it was related to blood not circulating properly in the legs.
That is the sum total of the evidence that a scientifically proven medical procedure is being denied by insurance companies. I must have missed the scientific evidence that the procedure actually works. Or for that matter any actual evidence that the procedure has been denied and for what reasons.
Sorry but it is not my responsibility to prove that your statement isn't true. You made the statement. If you are now admitting you have no evdence that certainly Should end the discussion as well as your credibility.
I don't know what the sum total is. I just know what I have observed. Insurance companies do not make decisions based on "Scientifically proven medical procedures". They do it on cost. It is why they will cover one drug but not another. Most any senior on Medicare D will eventually run into this. They do it also on frequency of procedures whether or not it is a "Scientifically proven medical procedure". They might cover an EKG during one visit, but not another, for instance. Insurance has different standards for screening vs. diagnostics for the same procedure and different insurance companies have different standards. Last I heard, medicare will cover a colonoscopy but will not cover the anesthesia other drugs they give you associated with the procedure, for instance. Now you surely are not trying to argue that anesthesia is not "scientifically proven" I hope. If so, you are just trolling.
Yes there is a list. Insurance companies have contracts with providers in their networks. Those contracts detail coverage. I don't think you're lying but you've not really presented any detail.
No, but clearly it is an untruth since I have had several colonscies and medicare has covered all costs associated. Now, admittedly I don't know anout anesthesia because it is not necessary for a colonoscopy. And you have still have yet to provide any evidence of scientifically proven and necessary procedures that insurance companes have failed to cover. Personal vague anecdotes and discussing Medcare do not constitute any evidence. So try again with actual proof if you can find any.
Since your husband is a sole provider surgeon/ physician surely you can provide some actual list of procedures he has performed and the names of the insurance companies that failed to reimburse. Should be pretty standard recordkeeping.
I consider your statement an untruth if you have no supplemental insurance seeing as how everybody I have ever known to have a colonoscopy has been sedated which is why they require someone to accompany them to the procedure so they can take them home; why none of them remember what the doctor said to them after the procedure about the procedure; and why it takes longer than the "few minutes" they think it took. Now I know of one instance when medicare covered the associated costs that were not normally covered with a colonoscopy because the patient was not notified that they could be charged for things associated with the procedure but not the actual procedure itself, but that is unusual. They are covered under §1879 ( https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c30.pdf ) And you have no proof that they cover every "scientifically proven and necessary procedure" but you know you are floundering since you have now added the "necessary". Almost everything is considered "elective" unless you are not breathing or are wheeled into the ER with a part of your body that is supposed to be there missing or something that is not supposed to be part of your body present or a part of your body that is supposed to be on the inside now on the outside.
So Far you have not named one single scientifically accepted procedure so your quibbles smack of desperation. Drop the necessary and you still fail. Keep trying to dodge though it s entertaining to watch.
