There is a paradoxical medical billing phenomenon known as de-authorization,

 Quite a bit of my blog material is taken from an article by  Dr.Saurabh Jah.

I have added my 2 cents worth.
Hope Dr. Jah will excuse me for  the plagiarism;-)
For people  who are in the know  this article is  hilarious ( the tongue in cheek style of Dr.Saurav ,and  infuriating, I wish  trump was standing in front of all the  health insurance headquarters saying "STUPID"

Case 1: Downgrading caviar to boiled salmon

"There is a paradoxical billing phenomenon known as de-authorization, coined by Richard Duszak, a radiologist from Emory, where if you bill for a less resource-intensive and cheaper study than pre-authorized by the insurer, the payment is denied. Once you’ve asked for caviar, you must eat caviar. And if you change your mind and want boiled salmon instead, that’s tough.

For example, if the patient is approved for a contrast-enhanced CT of the chest and you decide contrast is not needed, or may be harmful, and do the CT without contrast, and bill for CT without contrast, the payment will be denied. 

Worse, the patient will be lumbered with the bill (i.e. the chargemaster, price-gouging, flesh-eating bill). Not the discounted rate offered to insurers.

 The chief technologist saved the patient from a billing clusterfuck. But the insurer paid more for the study than would have if my clinical judgment was allowed to dictate the billing"

similar things happen when the utilization reviewer most likely a washed out  RN,decides I have  to do  plain xrays of Xy&Z before doing a MRI

Case 2: Cutting your nose to spite your face

" I phoned the insurer who connected me to a physician from the advanced imaging management elite squad — also known as radiology benefit managers. The chap, a most boring metronome, told me that the first line test for left-to- right shunt was an echocardiogram. I explained that the patient, a young professional with a demanding job, would have to take another day off work – we could easily nip the issue in the bud within five minutes. But the chap continued like a broken down record, “Our guidelines say echocardiogram first.”

I slammed the phone and muttered “ducking tosser” under my breath."

Case 3: Charity is fraud

“Just do it — put my name down. Say I insisted. And if it’s fraud to do more than I billed for, I’ll happily go to Guantanamo Bay for fraud.”

"I understand it is fraud if you buy a ticket from Philadelphia to New York and get off at Boston, but how is it fraud if you buy a ticket to Boston and get off at New York? Who makes these rules? Who are these people? Which parts of their brain light up on functional MRI? What do they eat for breakfast? How can a country which gave the world Edison, Wright brothers, and Kim Kardashian produce such imbeciles?"

The information to discern between physicians inducing their demand and physicians curbing their demand is too costly to obtain. So third party payers have a blanket rule: You can neither upgrade nor downgrade an imaging study, and if you do you’ll be paid nothing or will be done for fraud.

Don’t get me wrong; I’m flattered that I induce my demand in health care (I wish I could induce my demand in other areas, too). But a costly game of chicken is being played between payers and providers. It’s a game of reverse chicken actually, where both sides avoid staring at each other, and adapt to each other’s pathologies. The costs of this game may be forgivable, but the inconvenience to patients is inexcusable.

Disclaimer

The vignettes have been modified from their true state to protect patient health information and to protect the author from HIPAA vigilantes and bounty hunters. However, the gist of the vignettes is correct.