[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.