Dover – Delaware Insurance Commissioner Karen Weldin Stewart hosted a meeting of stakeholders on Tuesday to discuss pre-authorization denials in cardiac and other imaging tests. The Commissioner applauded her Department’s quick, professional and proactive responses to the initial complaint and praised the various stakeholders with whom she and her staff met the past year. The Commissioner, quoting a timeline (see below) drawn from internal department records and published newspaper accounts said, “The foundation of my administration’s approach to health care is ‘The Patient Comes First’. Our response to the initial and only complaint in two years made to the Department in connection with these denials from any source including doctors, patients, legislators and other health care agencies, a complaint made well after the patient had completed his surgery, was immediate. Our subsequent meeting with Blue Cross/Blue Shield of Delaware produced a suspension of all denials of services and was provided to a major Delaware media outlet, prior to any federal inquiry, on the condition that it not be made public.”
Making available a detailed timetable that verified the Commissioner’s original assertion, made last month in response to media criticism, that the care of the patient is paramount, The Commissioner said that the record clearly shows she and her staff took the initiative on every front including rapidly responding to the doctor, meeting with the carrier and securing an agreement on a moratorium. The Commissioner continued, “Since I took office, I and my staff have been consistently meeting with cardiologists, pulmonologists, oncologists, emergency room doctors as well as with insurance carriers, while visiting their facilities and hospitals in order to fully understand the many complexities that characterize health care and its delivery.”
The Commissioner concluded, “I will continue protecting you as I have successfully done in my first year whether it is on Worker’s Compensation litigation, regulating health insurance rates, securing over $600,000 in refunds to policyholders, increasing policyholder coverage in the case of an insolvency or the many other actions I have taken that will benefit all Delawareans.”
Timeline of events related to the Department of Insurance’s handling of a recent and high profile medical procedure pre-authorization case.
February 2010
The patient undergoes surgery in February. At this point in time, no complaints were made to the Department of Insurance pertaining to medical procedure denial(s) or to patient appeals related to denials.
March 10, 2010
The Department of Insurance receives a complaint letter* from the patient’s doctor informing the department that the pre-authorization process resulted in a denial of service. The doctor did not request the help of our office.
March 10, 2010
The Department of Insurance responds, in writing, to the doctor acknowledging receipt of the letter received the same day and offering the department’s assistance. The letter included references to our department’s legal authority and the types of services offered by our office including what information would be needed to assist with the appeal.
March 19, 2010
News Journal call results in a subsequent meeting with our Consumer Services Division. This is the first time the full extent of this case is presented and discussed. Our department immediately called and secured a meeting with BCBS.
March 21, 2010
The News Journal prints a news story about the patient who is the subject of the March 10, 2010 complaint letter filed by the doctor.
March 22, 2010
Insurance Commissioner Karen Weldin Stewart attends a meeting (previously scheduled) with BCBS executives which results in a moratorium on all denial of services relating to the medical pre-authorization process.
March 22, 2010
Insurance Commissioner Karen Weldin Stewart, in a conversation with the News Journal, informs a reporter about the denials moratorium on an “Off the record” basis. Resists public “grandstanding” on the basis that it might damage similar moratorium work in progress with other insurance carriers.
March 23, 2010
Same as above
March 25, 2010
US Senator Jay Rockefeller sends a letter to BCBS asking for information on the patient case in question and informing BCBS of his position with regard to the provision of health care service. The Senate Committee on Science, Commerce, and Transportation calls for an investigation of BCBS of Delaware (press release, below).
March 26, 2010
The News Journal publishes an editorial opinion highlighting Senator Rockefeller’s newly announced investigation and critical of the Delaware Insurance Department for being reactive.
March 27, 2010
The Delaware Insurance Commissioner announces that the department will launch its own investigation into the pre-authorization process.
March 28, 2010
The News Journal publishes another news article on the subject.
March 29, 2010
Doctor responds with patient-specific insurance information.
March 29, 2010
DOI sends formal complaint to BCBS of DE. They have 21days to respond.
*It is important to note that up until this time there have been no pre-authorization complaints received at the Department of Insurance related to medical tests for the past two years.
U.S. SENATE COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION
PRESS RELEASE, MARCH 25, 2010
Chairman Continues Push for Consumer Protection in America's Health Care Marketplace
Jena Longo - Democratic Deputy Communications Director 202.224.7824
Mar 25 2010
WASHINGTON, D.C.— In his continued effort to hold health companies accountable for how well they cover consumers, Senator John D. (Jay) Rockefeller IV, Chairman of the U.S. Senate Committee on Commerce, Science, and Transportation, sent a letter today to Blue Cross Blue Shield of Delaware (BCBSD) requesting more information on the company’s policy towards covering “stress tests.” This request follows recent reports that the company has routinely refused to cover these tests for their policyholders, even when doctors have deemed them medically necessary.
According to two recent stories in the Wilmington, Delaware News Journal, BCBSD has repeatedly refused to pay for “stress tests” for their policyholders who are showing signs of coronary heart disease, including severe chest pain. Stress tests help doctors diagnose coronary disease and determine patients’ risk to heart attacks and other heart-related conditions. As reported by The News Journal, BCBSD, acting through a third-party claims review company called MedSolutions, told a number of policyholders that the tests were not “medically necessary,” and refused to cover them, even though the patients complained of symptoms that strongly suggested heart disease.
“While we are making history here in Washington this week, we will need to continue to make sure that American consumers get the healthcare they pay for and deserve,” said Chairman Rockefeller. “As we implement health care reform, I intend to keep a close watch on the health insurance industry and will continue to ask tough questions about how they do business. Denying medically necessary services to patients showing signs of serious heart disease is not acceptable. That’s not how health care should be delivered in our country. American consumers deserve better and they are going to get it as health care reforms are implemented over the coming months and years.”
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Contacts:
Elliott Jacobson (302) 674-7303; (202) 294-3266 cell
Michael Gould (302) 674-7304
