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Your system of payment practices asks insurers, whether for profit or not-for-profit, to control costs.

Insurance companies limit or exclude various services and reimburse providers based on a reasonable and necessary basis. What are the ethical and legal dilemmas surrounding exclusions and reimbursement systems by third-party payers? What is 1 recommendation that you would have to minimize the ethical and legal dilemmas, while balancing the interests of patients, providers, and third-party payers?

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