Here's some background:
Blue Cross Blue Shield settles class action filed by 900,000 physicians, May 2007
Despite this huge settlement, Blue Shield of California keeps up the bad faith claims practices. Department of Insurance press release, December 2007 (by conservative Republican Insurance Commissioner):
Why are insurance companies allowed free reign to determine the medical necessity of medical care anyway? Especially after the care has already been provided and all they are doing is hurting patients, doctors, and driving up the cost of health care with monstrous and unnecessary bureaucracy to the tune of $450 billion a year?
If insurance companies want the right to deny care prescribed by a licensed doctor, they should have to describe specifically in their insurance policies, up front, the things they do NOT cover, so that doctors and patients can choose. If a licensed doctor deems the care medically necessary and prescribes it, and it isn't explicitly excluded, it should be covered. Period. If insurance companies don't like paying for a specific kind of care, they could, once a year, amend their exclusions and add that care. Then at least policyholders would be able to more honestly compare plans, and sick people could count on their coverage (rather than counting on being harassed out of their coverage) when they need it. And doctors could practice medicine again. AND it would take the incentive out of this hugely wasteful bureaucratic machine that insurance companies have created specifically to cheat sick people.