Even when they are a doctor, it doesn't matter.https://www.propublica.org/article/cigna-pxdx-medical-health...
Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show.
One thing that's bit me in the ass repeatedly with insurance claims is that the people approving/denying claims aren't doctors, and the people you have to fight to appeal a denied claim aredefinitelynot doctors. So even if you know the grounds for denial, sometimes the reason is bullshit and flies in the face of the insurer's own policies.
I spent months fighting a claim for mesalamine DR tablets (and getting nowhere) only to discover that the insurance personnel were treating it as a different claim for mesalamine EC capsules—a totally distinct formulation. Any doctor or pharmacist could tell you that they're not equivalent. But they had different approval criteria in the insurance system, and even though I met the criteria for the former (the drug I wanted) they kept denying me for not meeting the criteria of the latter (the drug I did not want).
But those are both oral forms. I think if they'd tried to run the claim as the suppository version, the error would've been more obvious.