Re:Big Insurance Met Match When Turned Down a Top Trial Lawy...
by lotsofpulp on Wednesday November 08, 2023 @08:57AM
(#38190335)
My point was the insurance company might be taking the heat for denying payment for the claim. For example, the lawyer in the article was 67 years old, and presumably had a Medicare plan sold by BlueCross BlueShield Louisiana (BCBSLA).
Was it BCBSLA that chooses to use Elevance for reviewing claims and the guidelines for those claims? Or does the federal government dictate using Elevance? And are there varying federal government standards for different insured populations?
I have not researched it thoroughly, but I can envision a situation where BCBSLA sells the government a “fall guy” role, and the government (taxpayers) save money by telling BCBSLA to use a more restrictive formulary or prior authorization criteria for certain populations.
Was it BCBSLA that chooses to use Elevance for reviewing claims and the guidelines for those claims? Or does the federal government dictate using Elevance? And are there varying federal government standards for different insured populations?
I have not researched it thoroughly, but I can envision a situation where BCBSLA sells the government a “fall guy” role, and the government (taxpayers) save money by telling BCBSLA to use a more restrictive formulary or prior authorization criteria for certain populations.