One of several health insurers under investigation by both Delaware Insurance Commissioner Karen Weldin Stewart and the U.S. Senate Committee on Commerce, Science and Transportation for potentially denying medically necessary diagnostic heart stress tests, Blue Cross Blue Shield of Delaware (BCBSD) in Trenton has decided it will no longer require physicians to get pre-authorization prior to performing nuclear stress tests on BCBSD members, Elliott Jacobson, Weldin Stewart's chief of staff, tells the News Journal.
Hartford, Conn.-based Aetna Inc. and Bethesda, Md.-based Coventry Health Care Inc. are also involved in the probes. Weldin Stewart had asked the health insurers to place a moratorium on stress test denials during her office's review, and BCBSD stopped denials for its entire advanced imaging pre-authorization program. Aetna (NYSE: AET) currently plans to end its moratorium on July 14 (which did not include other imaging exams such as MRIs). Coventry (NYSE: CVH) hasn't been willing to answer any questions about its pre-authorization activities.
All three insurers use evidence-based guidelines from MedSolutions to determine whether tests should receive authorization. MedSolutions has been quite vocal defending the denials in Delaware, as well as the general practice of pre-authorization, saying it stops costly, potentially dangerous tests from being performed unnecessarily.
To learn more:
- read this News Journal report