It's more that insurance companies don't like to change established protocols that they will pay for. They will pay for a homocysteine test, of course, as long as the doc talks to them nicely about why it's needed. It has to get approved and a doc will be thinking "can I sell this to the insurance company or will they push back?".

So the decision making happens at the insurance company level rather than the doctor level.

Given that that's the case, how does a doc follow a hunch, or innovate, or even personalize treatment? That's what set me off, the "personalized treatment" aspect of the posting. AIN'T EVER GONNA HAPPEN .. unless it saves money (never mind any curative nature of the treatment).

I used to care about global warming quite a bit, and act accordingly. However over the last few years I've concluded that it's beyond control, much like registering a gun for instance. Now a days I try to concentrate on things I THINK I can have some control over.