[lumost]

I don’t follow how the insurance companies doctor escapes liability in this case. If they are interfering with a patients treatment plan, doesn’t that qualify as practicing medicine?

Otherwise the insurance company could easily staff itself with less scrupulous poorly qualified doctors and say “your job is to reject claims”. Why would that doctor have any motivation or requirement to fulfill the duties of a “doctor”?

[jfengel]

It pays pretty well and you don't have to see any patients. And as they say, do you know what they call the one who graduates last in med school? "Doctor"

The problem with suing the doctor is that you need a fairly high standard of evidence to prove malpractice. If they have any way to say "this is not utterly unreasonable", they can claim it was your doctor's opinion versus theirs.

And the insurance company has many lawyers looking for ways to let them say that. It's why they have AI rather than just rejecting claims at random.

Though it appears they often do that as well. But the burden is still on you to prove it.