Those are good points and I do understand that there is a general belief that insurance companies deny medically necessary care. I have not had personal experience of this happening and working in the system I understood it differently. That doesn't mean I am right and you are wrong. We just have different experiences. It's been eight years since I worked for an insurance company so it's also possible there have been changes, including AI related changes.

The main thing I will say in response to your comment is that my understanding and experience has been that yes, there are a lot of things that are denied because they have not been established as medically necessary. Essentially any new treatment could fit into this category until studies have been done to establish efficacy. I gave an MRI example in my article but botox is another example. Botox is not covered for cosmetic purposes but it has been established as effective treatment for migraines. I believe this happened during my time at Aetna. The bulletins are constantly being reviewed and updated and there are provisions in place to appeal the denials, including expedited appeals that are resolved within a number of hours or days.

Many commenters have also seemed to indicate that there are no outside entities that insurance companies have to answer to and this is not true. Since most insurers participate in government run programs such as Medicare, they have to follow their guidelines. And, we always had to explain the appeal rights and processes so I know that there are outside entities involved.

Finally, I agree that no one wants to or should have to deal with appealing medical care, especially not when they are dealing with a serious illness. I guess I wanted to reassure people that there are protections in place. I didn't mean to insult anyone's intelligence or say their anger is unjustified. Thank you for taking the time to respond.