I think American healthcare is insane… and the slow sliding in the American style healthcare direction I see in the UK and even slower slide here in Australia, this slide is largely borne out of American healthcare business having no more room to expand and trying to export their business model overseas to expand their addressable markets… it’s insane to allow non medical professionals… to allow armies of accountants and actuaries… to decide how to treat patients.
It should be criminal, but it won’t be because the healthcare industry in America is so broken it will lobby till it’s broke to continue to be allowed to remain broken otherwise it might not be as profitable.
I think a licensed doctor/pharmacist employed by the insurance company has to make the decision, although, since they do not have liability exposure, I can imagine metrics can be imposed on them that make the quality of their work less than desirable.
If I don’t want to pay I can have a GP appointment with a short trip and a little wait sometime in the next 1-3 days… if I’m happy paying $40 Australian … I’ve got a GP appointment within walking distance tomorrow, no issues no bullshit, and I’ll even get some of that back from the government if I can be bothered, because anything that urgent is probably worth the money lol.
If I want to pay I can get specialist treatment, I’ve got private healthcare to cover fancy shit like regular physiotherapist sessions due to having an office job which will slowly and stealthily destroy your body no matter how careful you are… and glasses if I eventually need them… and stupid levels of dental because that’s my personal preference, if someone ever smashed out all my teeth I’m just completely covered … and that’s all on top of basically being assured care for anything serious disease or critical injury related by public healthcare… it’s just obviously the better arrangement. The most general risks are shared by the biggest pool of people paying for it… everyone paying for that with their taxes. If you want more… your free to buy it, and a lot of people do! It works great.
Similar for a close family member with a strange heart and immune condition.
InsuranceCo BCBS had some bureaucrat without even a medical degree directly second-guessing the tests ordered by the literal Director of Cardiology at the world-renowned Mayo Clinic.
All I can think is: "Who the fck are you to even begin to question this expert, and deny his recommendation?". Now, IFF they had some actual peer reviewing it (e.g., the head of cardiology at Cleveland Clinic or Harvard Med School), that might be legit, but this is nothing of the sort. It's like the tech giant's arbitrary terminating accounts with support, except instead of cutting off your livelihood, they are killing you.
It is the death of expertise. It seems like practicing medicine without a license and without even seeing the patient (which is legally required before writing many prescriptions).
Why it is even close to legal is utterly baffling.
(I hope your dad continues to recover)