In my time working with this stuff, I have been genuinely impressed with a consistent desire to cover evidence based and efficacious care from every insurance official I have spoken to. While the company as a whole may be profit driven, the guidelines they use to ration care seem completely appropriate and up to date. As physicians, there will be times that we are forced to justify what we do, but this should not be an undue burden. Throughout residency we are forced to justify what we do, and it makes us better doctors. Applying the same skills to creating a rational and well sourced argument for our actions continues to be necessary, and helps us to stay thoughtful and current. Embrace the opportunity to put real words on paper that really describes the course of care. It will make you a better doctor, and will get your therapies approved along the way.