Physicians diagnose and treat patients based on their professional experience,

Physicians diagnose and treat patients based on their professional experience, and extensive knowledge base. So why are non-physicians responsible for authorizing (or denying) insurance coverage for medical treatments? This pre-authorization ethical dilemma will be the basis of our discussion this week. For your initial post, you will debate both sides of this issue. In your response posts, you will express which side you align with most. Part I: Explain why physicians (employed by an insurance company) should be the ones to determine if a treatment or procedure is permissible and should be a covered benefit. Part II: Explain why non-physicians (employed by an insurance company) should be the ones to determine if a treatment or procedure is permissible and should be a covered benefit. Helpful Hints: The discussion board is asking that you evaluate if the Physician that is EMPLOYED by the INSURANCE company should handle the authorization determining if the service is authorized as covered. The next section is should a non Physician EMPLOYED by the INSURANCE company should determine if a service is covered or not. This non-physician can be many levels of people you would see at the insurance company such as a PA, NP, Midwife, CNS, RN, LVN. This would not refer to a receptionist or a biller in a clinic setting. Please be aware that this is not speaking of the provider in the clinic that sees the patients. They submit the authorization but do not have the ability to approve the service.

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