Medical necessity & the law, round 2

Austin blogged on this yesterday.  Go read his post first.

1. Baicker and Chandra get one detail wrong. The culprit is contract law, not corporate law. Blame corporate law for many things, but not this.

2. In cars, you can buy a Hyundai or a Lexus. In health care, people buy the Hyundai but expect a Lexus when they get cancer. So Einer is still generally right on consumer insurance contracts, but take a look at the list of clinical policy bulletins on your health insurance website (Aetna’s list is here). Companies have gotten better at defining the scope of coverage when they have negative evidence on a procedure, device or drug.

3. Health plans are now offering tiered provider plans. In Boston, the Tufts Your Choice plan has a $1500 deductible for Mass General and a $500 deductible for BMC. This delegates the choice to the consumer in a way that should survive contract law.

KO

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