Why can't insurers be arrested for practicing medicine w/o a license?

[Joe Fields]

When you think about it, when an insurer, such as Cigna denies medical treatment to a policyholder, whose primary doctor ordered said medical treatment, (be it a mammogram, colonoscopy, MRI), then in a very real sense, it is the insurer who is the one practicing medicine on the patient. THEY DO NOT HAVE A LICENSE TO PRACTICE MEDICINE. Not only are they practicing medicine, but it is MEDICAL MALPRACTICE, and they should be able to be sued for interfering with and overriding a licensed Doctor's prognosis and prescribed treatment.

[armyowalgreens]

1. Many of the ones making the decisions DO have a license to practice medicine.

Insurance companies have a staff of MDs working for them.

[Mind_your_head]

6. Are you SURE about that?

your said: Insurance companies have a staff of MDs working for them.
and IF, in fact they do (have a staff of MD's working for them ~ which I doubt), who is to know that the "staff of MD's aren't the type of MJ's Dr. Murray....who would say/do ANYTHING as long as he gets his compensation......

[armyowalgreens]

9. Where did I say that they were saviors of their profession?

All I said was that they are MDs.

[Mind_your_head]

15. Fair enough.

Some people who have had a medical degree conferred upon them are much better off (and any actual PATIENTS ARE BETTER OFF)when these Dr.s work for the insurance industry, rather than 'practice' on real, live people.

I agree with you

edit to add: 'than'

[CC]

2. I may be wrong because I am going

on memory but I think it was determined that they weren't "practicing" medicine. I can't remember if it was a court case or legislated though just that it pissed me off.

[SemiCharmedQuark]

3. They aren't denying treatment. They just are denying payment for treatment.

And although the end result is the same, they are two very different things.

[flvegan]

4. Because they aren't denying treatment, only payment for it.

You can do whatever you want, but be prepared to pay for it.

[Joe Fields]

7. demonstrably not true.

Take me, for example. I need neck surgery, back surgery, and at my age, a host of small ailments. If I had insurance, which I cannot get, because of pre-existing conditions, and I were to be denied any of those procedures, I have no other means of payment. Therefore, the insurer IS the doctor.

If the insurer is overriding sound medical judgement, then they are, in effect practicing medicine.

[armyowalgreens]

10. It's actually correct. They are technically not denying treatment

[Joe Fields]

12. If taken on a case by case basis, if proven that the patient has

no other means of payment, then I strongly disagree with you. They are practicing medicine by usurping the authority of medical professionals and in a convoluted way, practicing through denial of service.

[armyowalgreens]

13. No, you're wrong. They are denying payment for treatment.

It doesn't legally matter that one cannot afford payment without it. The doctors could do it for free or some other method of payment could theoretically be found.

On a moral level, you are correct. On a legal level, you are wrong.

[Joe Fields]

16. I really wasn't arguing from a legal standpoint.

If it were legal, we wouldn't be in this mess. I was just opining as to the morality of it, and that it SHOULD be legal to sue them for defacto malpractice.

[armyowalgreens]

17. "it SHOULD be legal to sue them for defacto malpractice."

I don't really feel like setting emotionally based precedent. That could really come back to bite us in the ass.

[excess_3]

11. it's the greedy bastard doctors who deny you treatment. nt

[flvegan]

14. The insurance company isn't overriding anything.

Unfortunately, your means is. Were you a billionaire, you'd promptly have your procedure, yes? You'd pay cash, case closed.

[Fridays Child]

5. They employ doctors who sign off on all medical decisions.

But, their denial archives, are probably malpractice goldmines. Maybe some savvy (and hungry) attorney ought to advertise for plaintiffs in a class action suit against the insurance giants, and challenge all of their death panel decisions.

[Joe Fields]

8. I like that idea.

I didn't realize that medical decisions by insurers were made by employees with medical degrees. Thank you. I still think it should be looked into, just in case there are some who aren't licensed making those death panel decisions.

[Fire_Medic_Dave]

18. They aren't denying treatment, they are denying payment or coverage.

[Statistical]

19. From a legal standpoint they aren't preventing you from getting ANY treatment.

They are simply not paying for it.

If you doctor says you need this $1.5 million treatment and the insurance company said no and you wrote a check for the $1.5 mil the doctor would do the treatment.

Lack of willingness to pay for something can't be construed as a lack of treatment, at least not legally.

[ddeclue]

20. It would be better to prosecute them for wire and mail fraud.

That's what they are engaged in after all.