“Your insurance company says you need surgery. Can they make you have surgery? No, but they can enforce a provision that says you need to be under the most appropriate care for the condition causing disability. So if surgery is an option, we look at the risk factors. Is it more than 50%, that the risks outweigh the benefits? Then you can argue, no. It’s too risky.”
What if, when you had your wisdom teeth out, you had a terrible reaction to anesthesia? You were pregnant, you had an epidural, you had a terrible reaction to it. You had a minor surgery and the healing process was really, really difficult. Those are risks. The risks outweigh the benefits, the insurance company can’t make any good argument about needing surgery.