> Insurers most often turn to two sets: MCG (formerly known as Milliman Care Guidelines), developed by a division of the multibillion-dollar media and information company Hearst, and InterQual, produced by a unit of UnitedHealth’s mental health division, Optum. Insurers have also used guidelines they have developed themselves.
Presumably, the guidelines were written by medical professionals.
> In interviews, several current and former insurance employees from multiple companies said that they were required to prioritize the proprietary guidelines their company used, even if their own clinical judgment pointed in the opposite direction.
In medical care, the attending doctor should be the one taking final call. Otherwise, we'd all be receiving medical treatments based on a bunch of flowcharts.
Presumably, the guidelines were written by medical professionals.
> In interviews, several current and former insurance employees from multiple companies said that they were required to prioritize the proprietary guidelines their company used, even if their own clinical judgment pointed in the opposite direction.
In medical care, the attending doctor should be the one taking final call. Otherwise, we'd all be receiving medical treatments based on a bunch of flowcharts.