Insurance companies in the US often exhibit paradoxical behavior based entirely on statistics and ignoring individual case details.
Often a less expensive procedure will be denied until after a more expensive procedure is performed, guaranteeing that insurance has to pay for both, just because some significant percent of patients need the more expensive procedure either way.
Health insurance is utterly stupid, and mainly because it’s a for-profit, private enterprise in the US. Data goes in and a decision comes out, and the insurance companies really only care as long as the algorithm results in a net profit over time. Good outcomes for patients isn’t even a consideration.
Insurance is pure capitalism, using all their data and statistics to streamline care and minimize costs (for them, not for us). Sometimes it does work for the people’s benefit, but most of the time it doesnt. For example, I have been told it is in insurance companies best interests to cover contraception to avoid having to pay the much higher costs of pregnancy later. Which is a positive.
They could have found that the x-ray identifies hairline fracture or something else that is misidentified as a tear. Or they are just shitty ¯_/(ツ)_/¯
Insurance companies in the US often exhibit paradoxical behavior based entirely on statistics and ignoring individual case details.
Often a less expensive procedure will be denied until after a more expensive procedure is performed, guaranteeing that insurance has to pay for both, just because some significant percent of patients need the more expensive procedure either way.
Health insurance is utterly stupid, and mainly because it’s a for-profit, private enterprise in the US. Data goes in and a decision comes out, and the insurance companies really only care as long as the algorithm results in a net profit over time. Good outcomes for patients isn’t even a consideration.
Insurance is pure capitalism, using all their data and statistics to streamline care and minimize costs (for them, not for us). Sometimes it does work for the people’s benefit, but most of the time it doesnt. For example, I have been told it is in insurance companies best interests to cover contraception to avoid having to pay the much higher costs of pregnancy later. Which is a positive.
They could have found that the x-ray identifies hairline fracture or something else that is misidentified as a tear. Or they are just shitty ¯_/(ツ)_/¯