'Why pay for a Cadillac, when a Chevy will do?' How does the saying go? If I had a nickel..? So it goes with this phrase; repeated by rehabilitation claims reviewers and insurance payers, demonstrating that there is a growing national trend towards evaluating the medical necessity of a claim simply for its overall cost. Generally, an understanding exists between payer and beneficiary, that any catastrophic, illness or event involves an issue of financial responsibility. However, the expectation persists that insurance will provide for the purchased services.