THe long and the short- If you make up your own criteria for what is medically necessary, and then deny people based on your narrow viewpoint, then you make money.
Toubman, who represents indigent clients as a member of the New Haven Legal Assistance Association, fears the HMOs have created their own definitions of what services are "medically necessary" or "medically appropriate" and are rejecting legitimate claims.
Since the Workers Insurance dudes do the same thing, it will be interesting to see what happens if the Insurance Co is found guilty. What will be the implications for other insurers???
Hehehe... I like this dude.