Their excuse is that they aren’t “overruling the doctor”, they just aren’t going to pay for it. Never mind that in the US it’s functionally the same thing.

They will just say “you do what you think is best for the patient doc. We just disagree and aren’t going to cover it.” It forces doctors, hospitals, rehabs, and nursing homes into situations where they either have to provide care for free, or not at all. I’ll never understand how we allowed things to get this bad.

I live this every day. I’ve had a United Medical Director tell me that being able to feed yourself was “not an essential skill” worthy of rehab because it could be performed by staff or a family member.

This man tried to tell me that my patient in their late 60s was unworthy of a rehab stint for strengthening their upper arms to be able to feed themselves because someone else could do it for them for the rest of their lives.

Stay the hell away from Medicare Advantage plans. No matter what they promise, it’s irrelevant because they won’t actually provide it when the time comes.