Most Give Their Health Plans Passing Grades
(continued)
continued...
"We look at the physician as being key to decisions of medical necessity, determining medical necessity, and appropriateness," Trachtman tells WebMD. "The study shows that nearly one-fifth of individuals report delays in coverage. So the physicians making that determination would be the arbiters of what should and shouldn't be covered within the workings of the plan. It's possible that some of these things that were denied were correctly denied. But we have to make sure the decision is made with a firm medical basis rather than cost or other considerations."
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