Just had another request for a "letter of medical necessity" land on my desk. That's where the insurance company, which already has every medical record it needs, creates up to an hour of work for me. I get to explain my reasoning for treatment using the same paperwork I already sent them. In the letter, I explain that their cherry-picked rationales are population-based and don't apply to every patient. I explain that they, the insurance company, don't have a license to practice medicine, and their sellout doctors don't have a license to practice in my state. Their protocols were meant to get us to a peer-to-peer, not to dictate medical care. They were asked to hold their subscribers' money in case they needed it, and that money is, in fact, not theirs. And I note that I understand the only reason for this unpaid, unfunded waste of time is to discourage me from writing the letter at all. If a lawyer wrote the masterpiece I produce, it would be billed out at thousands of dollars. Mine isn't paid at all. It costs me time with patients, who are already backed up because the new CMS rules make me see them twice for the same problem. And it costs me time with my family. whew.....