California Lawsuit Takes Aim at Defining ‘Medical Necessity’
A lawsuit that goes to trial in Los Angeles Superior Court this week raises questions about whose opinionÂ should carry the most weight when determining what is medically necessary. A lawyer for the plaintiff argued that the opinion of the patient's physician should carry more weight than a doctor hired by an insurance company to review claims. A lawyer for the defense could not be reached, but the insurer in court briefs argued that its policy's coverage was "plain, clear and unambiguous."
- "Man Says Doctor's Order Trumps Insurers'" (Gallegos, Los Angeles Daily Journal, 3/2).