Being a middleman has never been popular. But it appears that radiology benefits managers, or RBMs, really have their work cut out for them. According to a Wall Street Journal article, RBMs, which help insurance companies decide whether or not high-tech scans are absolutely necessary, often cause "delays or rejections" that "pose risks for patients."
The article uses the example of a man in Texas who, in 2006, was ordered to get PET scans every three months for two years after being treated for lymphoma. American Imaging Management and Blue Cross and Blue Shield of Texas, which insured the man, forced to him to get pre-approval before each scan, causing delays. In July 2007, the man suffered a seizure caused by a new tumor between the two lobes of his brain. While Blue Cross denies any wrongdoing and says it always responded promptly to requests made, the man's doctor feels differently.
"Every time we scanned him, we had to go through a lengthy approval process," Dr. Edward Agura said. "Delays in approval lead to cancers coming back and not being detected."
RBMs also can cause pain in your wallet, as pointed out in the article through the example of Leslie Hammer. Hammer had breast cancer in 2005 and was treated, but was denied coverage for an MRI recommended by her surgeon, oncologist and radiologist because her insurance, Oxford Health Plans, deemed an MRI "not medically necessary." She paid out of pocket for the scan.
- read this Wall Street Journal article