[lotsofpulp]

> Besides the fact the premiums are onerous, it is the health insurance carriers that evaluate if and how much insurance will cover an expenditure, usually after a copay and possibly coinsurance has been paid.

This is not true. ACA requires health insurance companies to pay for all healthcare expenses after reaching one’s out of pocket maximum.

And they have some discretion to call out fraud, but insurance companies have to by and large follow medical procedure guidelines. They don’t have to cover experimental treatments, but if they are denying appropriate healthcare, they would get nailed by various government agencies.

[Bubbadoo]

The 'ACA' is not one plan and it certainly does not require health insurance carriers to pay for 'ALL' healthcare expenses after you reach your deductible. Coverage varies by state and by level (ie., gold or platinum). Many plans do not cover out-of-network doctor visits for example. On top of this, you need to get prior approval for every medical procedure because not ALL are covered. In some cases, the insurance company will recommend a different treatment, instead of the prescribed treatment. I speak from experience.

AHCA coverage is superior to what we had before, but it isn't enough. It was drafted with the Health Insurance lobby in the room, so do the arithmetic.

[lotsofpulp]

ACA requires insurers to pay for all healthcare expenses at in network providers for coveted procedures, unlike pre ACA where the insurer could simply stop paying at a certain dollar amount.

And health insurance does recommend different treatment depending on what the insurance’s doctors think. That’s the entity with the knowledge to be able to challenge a doctor, since the patient rarely has sufficient knowledge to do so.

The alternative system of a check and balance is if the government pays for healthcare and a government employed doctor approves or suggests alternative treatment. That’s what the UK does.

Either way, you have to have a second opinion to avoid mistreatment or overcharging by the healthcare provider. This isn’t an issue specific to healthcare, it’s present in any sufficiently complicated field.