 |
|
Sen. Rockefeller Following IC Stewart's Lead on Denials Probe By JONATHAN STARKEY • The News Journal • October 28, 2010 We’ve heard on pretty good authority that the U.S. Senate Commerce Committee, led by chairman Sen. Jay Rockefeller (D-W.Va.), is taking its cues these days from Karen Weldin Stewart and the Delaware Department of Insurance. At least on their mutual investigations into insurance denials. Both the committee and Stewart are looking into insurance company practices in Delaware of requiring that doctors obtain permission before performing certain diagnostic procedures. They launched the probes after The News Journal published a series this spring suggesting that Blue Cross Blue Shield of Delaware and others were putting patients at risk by inappropriately refusing to pay for important diagnostic tests through a third-party. Stewart said this week that results should be published in a publicly available report by January or February. And apparently Rockefeller & Co. are waiting on those results to move forward. Rockefeller’s March 25 letter to Blue Cross’ president Tim Constantine caused quite a splash here this spring, but the committee has been pretty silent in the last several months. Word that they’re waiting on Stewart helps to explain that somewhat. At the center of the controversy was the use of nuclear stress tests — which use a radioactive material and imaging to identify artery blockages — on patients showing signs of heart disease. One Blue Cross customer, Michael Fields, of Elkton, Md., was denied coverage for a nuclear test three times before doctors admitted him into Christiana Hospital and identified severe arterial blockage threatening to cause a life-threatening heart attack. Fields later underwent quadruple bypass surgery. Rockefeller’s first letter to Blue Cross asked for records of pre-auth denials. In April, the committee sent similar letters to Coventry Health Care and Aetna. Blue Cross has backed off of its pre-authorization requirements for cardiac testing, and is working with Delaware cardiologists and the national American College of Cardiology to develop an alternative. Aetna resumed, and even expanded, its pre-authorization program last month. We’re not completely sure what Coventry is doing; it’s been difficult to get a comment out of them. For their part, the insurance companies have said their pre-authorization programs are only meant to limit unnecessary testing, which can be harmful and costly. A June report from the Medicare Payment Advisory Commission, which advises Congress, suggested that the government look into a targeted pre-authorization program for Medicare. Overuse of advanced imaging exams is, in fact, a pretty well-documented, and heavily-debated, issue in American health care. |
