Quote:
Originally Posted by photon
To me the question would be how does an insurance provider decide if medication a or treatment b or item c is efficacious for a given condition and is a reasonable item to pay out.
Do they make all those decision in house? Like have a team of people that read the latest studies and update the relationships and such? Or maybe there's a 3rd party provider that provides a database of such information? How often do they get updated?
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they usually have some trained medical and dental professionals on staff, and then likely have arrangements with medical consultants
as a rule of thumb, they generally provide coverage for the least cost alternative