“Remember that your Blue Cross and Blue Shield Policy does not cover the cost of hospitalization or any health care services and supplies that are not Medically Necessary. The fact that your Physician or another health care Provider may prescribe, order, recommend or approve an Inpatient admission or continued Inpatient hospitalization beyond the length of stay authorized by the Blue Cross and Blue Shield Physician does not of itself make such an Inpatient Hospital stay Medically Necessary. Even if your Physician prescribes, orders, recommends, approves or views an Inpatient admission or continued Inpatient hospitalization beyond the length of stay assigned by the MSA as Medically Necessary, Blue Cross and Blue Shield will not pay for an Inpatient admission or continued hospitalization which exceeds the assigned length of stay if the MSA and the Blue Cross and Blue Shield Physician decide an extension of the assigned length of stay is not Medically Necessary.”
My policy is not all that unique - yours probably has this clause too. In effect, the decisions that you and your doctor make may be deemed "medically unnecessary" by the free-market insurance bureaucracy.
I am no more comfortable with a free-market, profit oriented bureaucracy interfering with my doctor's recommendations than I am with a government bureaucrat doing the same thing. Something needs to change.
Next post: the clause that drives insured people to bankruptcy.