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Wielding The Wand Without Facing The Music: Allowing Utilization Review Physicians To Trump Doctors’ Orders, But Protecting Them From The Legal Risk Ordinarily Attached To The Medical Degree, Katherine L. Record

Duke Law Journal

This Note identifies a discrepancy in the law governing the decisionmaking that directs patient care. Seeking treatment that a third party will pay for, a patient needs not only a physician-prescribed course of treatment but also an insurer's verification that the cost is medically necessary or otherwise covered by the patient's plan. Both of these decisions directly impact the ultimate care delivered to the patient, but are governed by two very different liability regimes. A patient who suffers an adverse outcome may sue his physician in tort, while a patient who suffers from a lack of coverage may generally sue …