Yes, many insurance companies deny in the very same way. They often take their cues from Medicare.
The difference is that the worst thing an insurance company can do is not pay. Medicare can and will criminally prosecute if a doctor does things for his patient which don’t follow Medicare’s coverage rules. And as I said, my experience is that our physician community believes that template will be carried over to a single payer system.
In fairness, there are some government prosecutions for real fraud against the program and the patients. Here’s an example -
- and I am totally in favor of going after that sort of scum. But that’s very different from punishing a physician for performing a life saving and life enhancing procedure on a patient.
