By: Ron Peck. Esq.
I recently found myself in a doctor’s waiting room. I overheard another patient arguing with the office administrator. The gist of it was that he was being balance billed for an amount exceeding what insurance paid. His anger was directed at the insurance. “How can they say what is medically necessary? Only the doctor can say what’s necessary.” A nurse emerged, and to her credit, I heard her explain that insurance defines medical necessity as the least costly option likely to resolve the medical issue. She then explained that the doctor provided the patient with options, and he chose the option that was more intensive. That another, less thorough treatment might have resolved the issue. Well done, I thought. Yet, to my horror, the patient screamed, “Insurance! Crooks! How dare they decide what’s necessary! They aren’t my doctor.”