The public might “understand” but do they really understand? Do you feel that when things don’t go the way the patient wants, that the conclusion is it rests on the physician? Or do you feel the public understands the role of the system? An old article (https://thecapitolforum.com/not-medically-necessary/), but here’s a direct quote regarding difficulties with the prior authorization process: “Holding the companies legally responsible for their decisions is also difficult. In 2022, Carelon settled a lawsuit for $13 million that alleged the company, then called AIM, had used a variety of techniques to avoid approving coverage requests. Among them: The company set its fax machines to receive only 5 to 10 pages. When doctors faxed prior authorization requests longer than the limit, company representatives would deny them for failing to have enough documentation. Carelon denied the allegations in court and admitted no fault. A spokesperson declined to comment on the lawsuit.” This is old, and only one thing that was caught.   submitted by   /u/Hot_Pineapple_8435 [link]   [comments]