Ama Policy

Denial of Payment for Medical Services Based Solely on Fiscal Considerations H-385.985

U.R. Criteria
Our AMA: (1) affirms that medical judgment as to the need for an assistant in any surgical procedure, or the need to provide any form of medical care, should be made by the physician based on what is best for the health and welfare of the patient and not on fiscal restraints or considerations; and (2) opposes any law, rule or regulation, or any decision by a third party carrier which denies payment for medical services due solely to fiscal considerations and which does not have as its primary purpose the health and safety of the patient.

Policy Timeline

Res. 12, A-86 Reaffirmed: Sunset Report, I-96 Reaffirmed: BOT Rep. 32, A-99 Reaffirmation A-02 Reaffirmed: CMS Rep. 4, A-12; Reaffirmed: CMS Rep. 1, A-22