The whole medical claim process is contractual. The insurance people that determine what they will provide put it into a contract that the insured determines to be adequate for them and they sign. It’s as simple as that.
If you go into a medical emergency for a heart attack and decide while you’re in you are going to get your nose fixed, that isn’t part of the deal. You pay for that or you find an insurance comapny that will cover cosmetic surgery. And everythng is to support the business. If the insurance company doesn’t exist, there is no coverage of anything.
This crying over the limitation of a doctor to do work and trying to blame the HMO so they can cop out of possibly being cheated out of their pay by the public is nothing more than finger pointing. The HMO’s are up front with what they will and will not cover. And they do not cover everything all the time. Some cover more than others but you pay for that. Medicine like building a house is business. And the amount of money you are willing to spend will destine the size of the house. But that decision is yours and not the doctor’s. He is only concerned with getting paid to do services. Ask him/her if he/she would do it for half off? You’ll get your answer. And trying to mix emotion with business doesn’t always end happily. But conractual committment is solid or can be made that way.
wy69
What you said, if it isn’t covered in the policy, it’s on you. READ your policy coverage and always, always demand the provider get a preauthorization.