Doctor/Nurse Malpractice and Health Insurance

Health insurance companies have staffs of professionals rendering their opinions regarding medical services. Beyond understanding the language of contract law, these individuals advise regarding the coverage of certain treatments. So, in the recent case of the transplant patient, Cigna staff physicians rated survival for the transplant that was initially denied.

Turn around is fair play. I believe that these professional advisers, who are not lawyers, but are health services providers, such as doctors and nurses, should be sued when their negligence, or deliberate, knowing conduct results in harm to insureds. These individuals should not escape the requirement of carrying insurance--malpractice insurance. Right now, such policies are fairly cheap for nurses, more expensive for physicians, but certainly more affordable than health insurance for citizens.

Once people start holding these faceless "professionals" responsible for their contribution to the misery of insureds, perhaps they too will become more responsible, more defensive (and then like other professionals tend to overprescribe authorized treatments rather than underprescribe treatments), and start experiencing the real consequences of their actions.

There seems to be a safe haven for these voices over the phone, or members of groups determining whether individuals are covered by health insurance. Typically, the safe haven of we're not prescribing medical care, we're just saying whether or not we'll cover it, used by insurance companies has protected these staffers from professional responsibility as health services providers. This does not make sense. A nurse, or physician is not hired by a health insurance company for their business know how, they are hired as consultants on professional care standards and procedures. If they tend to make decisions that advise against covering a medical treatment, it is based on medical knowledge, if that knowledge is wrong, they should be held liable.