David Bianculli

And in other cases, sort of misrepresenting what his care was all about. And, you know, finally, Chris did what... win his case. You know, he won an agreement from the company to continue his care. A lot of details of that settlement are not public, but it took a tremendous effort. And most people are not so equipped to do something like that.

And in other cases, sort of misrepresenting what his care was all about. And, you know, finally, Chris did what... win his case. You know, he won an agreement from the company to continue his care. A lot of details of that settlement are not public, but it took a tremendous effort. And most people are not so equipped to do something like that.

In fact, it's so rare to find somebody who's actually sued their health insurer over denied care. It's an expensive proposition. People are sick. They don't necessarily want to go through it. So his case was extraordinary, both in what it revealed and the outcome.

In fact, it's so rare to find somebody who's actually sued their health insurer over denied care. It's an expensive proposition. People are sick. They don't necessarily want to go through it. So his case was extraordinary, both in what it revealed and the outcome.

In fact, it's so rare to find somebody who's actually sued their health insurer over denied care. It's an expensive proposition. People are sick. They don't necessarily want to go through it. So his case was extraordinary, both in what it revealed and the outcome.

Well, they didn't answer my specific questions, but did say that they ultimately paid for his care. And they did point out that the dosages he was receiving, you know, exceeded what was in FDA guidelines, which, you know, his doctor said was necessary to get his disease under control.

Well, they didn't answer my specific questions, but did say that they ultimately paid for his care. And they did point out that the dosages he was receiving, you know, exceeded what was in FDA guidelines, which, you know, his doctor said was necessary to get his disease under control.

Well, they didn't answer my specific questions, but did say that they ultimately paid for his care. And they did point out that the dosages he was receiving, you know, exceeded what was in FDA guidelines, which, you know, his doctor said was necessary to get his disease under control.

These companies essentially review claims from insurance companies' insureds and decide if they should be paid. So they're farming out the work of deciding what's appropriate care for their patients. And this is a growing business. You know, one of the things we found is that companies are engaging in a lot of prior authorization where you can't get a treatment or a drug until they say it's okay.

These companies essentially review claims from insurance companies' insureds and decide if they should be paid. So they're farming out the work of deciding what's appropriate care for their patients. And this is a growing business. You know, one of the things we found is that companies are engaging in a lot of prior authorization where you can't get a treatment or a drug until they say it's okay.

These companies essentially review claims from insurance companies' insureds and decide if they should be paid. So they're farming out the work of deciding what's appropriate care for their patients. And this is a growing business. You know, one of the things we found is that companies are engaging in a lot of prior authorization where you can't get a treatment or a drug until they say it's okay.

And for patients, this can be really disturbing. A lot of them have said that, you know, essentially the insurance company is playing doctor and deciding what I should get for care rather than my own doctor deciding it.

And for patients, this can be really disturbing. A lot of them have said that, you know, essentially the insurance company is playing doctor and deciding what I should get for care rather than my own doctor deciding it.

And for patients, this can be really disturbing. A lot of them have said that, you know, essentially the insurance company is playing doctor and deciding what I should get for care rather than my own doctor deciding it.

That is certainly a real thing, and I've actually written about some of that in the past. I think what has happened is that it has been broadened to such a degree that it covers a wide swath of care. You know, cardiology, there's a lot of reviews. Oncology, there's reviews.

That is certainly a real thing, and I've actually written about some of that in the past. I think what has happened is that it has been broadened to such a degree that it covers a wide swath of care. You know, cardiology, there's a lot of reviews. Oncology, there's reviews.

That is certainly a real thing, and I've actually written about some of that in the past. I think what has happened is that it has been broadened to such a degree that it covers a wide swath of care. You know, cardiology, there's a lot of reviews. Oncology, there's reviews.

Certainly in the orthopedic world, you see a lot of insurance companies applying their own medical guidelines and analysis in determining whether someone should get that care. So I think it's true that there are cases where doctors over-prescribe or order tests that aren't necessarily needed, but this is broadened into a large practice of deciding what patients should get.

Certainly in the orthopedic world, you see a lot of insurance companies applying their own medical guidelines and analysis in determining whether someone should get that care. So I think it's true that there are cases where doctors over-prescribe or order tests that aren't necessarily needed, but this is broadened into a large practice of deciding what patients should get.

Certainly in the orthopedic world, you see a lot of insurance companies applying their own medical guidelines and analysis in determining whether someone should get that care. So I think it's true that there are cases where doctors over-prescribe or order tests that aren't necessarily needed, but this is broadened into a large practice of deciding what patients should get.