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Why is it in the "free market" health care system of the United States, doctors need permission from insurance companies to order test?

"pre-authorization" No that is not fancy doctor talk. That is a decision made by someone in a cubicle at the insurance company who says you go for an ultrasound first because it's cheaper. Then if that shows nothing, you get the MRI. Talk about waste.

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  • 4 weeks ago

    Doctors have to find out if the insurance company will cover their share of the cost, of course. Without that, people would get all kinds of tests and treatments and expect insurance to cover it. That is a financial decision of the insurance company. They are a profit making concern. If you dont want to use insurance you may pay cash.

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  • TedEx
    Lv 7
    1 month ago

    Gotta love it! People bitXh about the high cost of health care, but balk about  insurances' making an effort to curtail excessive costs.

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  • 1 month ago

    the person/company that is paying the bill gets to make the decision 

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  • 1 month ago

    Not a waste.  Go to a doctor and tell them you're cash pay and see how they treat you differently.  I do that, and it really gets you thinking.  I've had, "Well...I'd normally run all these tests, but since you're paying for it I'd really only recommend this one."

    That's a waste, because when they know things aren't needed, but don't care, that's WHY government run ANYTHING doesn't work.  It's very easy spending someone else's money.  But, when it matters, people move a little more thoughtfully.

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  • Scott
    Lv 6
    1 month ago

    Doctors only need permission if they expect to be paid by the insurance company. Their wallet - their rules.

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  • 1 month ago

    Because the "insured" signed a contract with the insurance company that allows this.

    If you don't want to deal with this, pay cash for your treatment or select an insurance plan that doesn't require this.

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  • martin
    Lv 7
    1 month ago

    Insurance companies are in it for the money. The American Medical Association guarantees doctors remain wealthy.

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    • Anonymous
      Lv 7
      1 month agoReport

      Grocery stores are in it for the money. Senators are in it for the money. Schools are in it for the money. Non profits. Churches. Name an entity that isn't.

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  • 1 month ago

    Thats just about getting someone else to pay the bill...

    If you want to pay cash, they will run every test you want.  

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  • ?
    Lv 6
    1 month ago

    You're 100% pre-authorized to do whatever you want. That's just what the insurance company says they'll pay for, which makes sense because if you have anything done in the ER, you're buying a new car at minimum.

    Sure, those insurance companies are not exactly operating on paper-thin margins, but paying whatever the hospital wants is a great way to suddenly not have a company. They'll charge you the value of a small city for a Tylenol if you let them.

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    • Casey Y
      Lv 7
      1 month agoReport

      You are correct, CEO compensation would be included...but the CEOs make peanuts compared to the stockholders...

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  • 1 month ago

    First, the doctor doesn't need permission. The test can be done. The problem is getting someone to pay for it. If your insurance won't and you can pay for it yourself, you can have the test. 

    But you have a good point about the power of insurance companies. And they skim billions off the top of our health care dollars. That's why it would be cheaper to take them out of the equation. 

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