Whenever a doctor is dealing with insurance companies, their reports must be consistent with the guidelines set for by the insurance companies in order to be paid. The doctor’s fees must be consistent within the insurance’s parameters for the “usual, customary, and reasonable” fees, or the insurance company will not pay for all the doctor’s bills.
This also holds true for insurance companies’ parameters for length of treatment, kinds of treatment, and who will be the treating doctor all depending on the various traumatic injuries. If the doctor’s treatment exceeds the normal parameters for a stated diagnosis, the insurance company will claim over utilization for that diagnosis and will not approve the claim, and will ultimately refuse to be responsible for the claim and that has nothing to do with the patient’s actual condition..
Many doctors object to the insurance company parameters as being too conservative and often wonder how the insurance company even arrived at this policy guideline. The answer is simple. In the US we have a clearing house of insurance statistics which monitors every claim from its diagnosis coding, treatment coding, treatment time periods, and then arrived at the average parameters and then compare it with the patient’s care.
These treatment guidelines are also influenced by politics, money available, insurance coverage purchased, With Obamacare, there will be added features that are not fully recognized until it goes into effect and the whole health industry from patients compliance to Obamacare, insurance compliance to Obamacare, Doctors and their complaince to Obamacare, and all the other companies involved in providing health care products and services.
The future of Health care is going to be undergoing changes that will soon be all too evident as to its effectiveness, efficiency, and its over all improvement to patient’s health.