Blue Cross/Blue Shield denied needed medical tests, Senate finds

[brentspeak]

The story leads off with the case of Michael Fields, who was denied coverage of a stress test three times by Blue Cross' screening service.

http://www.msnbc.msn.com/id/42613298/ns/nightly_news/

By Lisa Myers, Rich Gardella and Azriel Relph
NBC News
updated

snip

A http://commerce.senate.gov/public/?a=Files.Serve&File_id=f149ce0b-823f-48cb-9d74-68a97f0ecd27">Senate investigation released Friday found a pattern of inappropriate denials for tests like the one Fields’ doctors say he should have received from the start.

The investigation looked at 1,600 cases over a six-month period from 2009 to 2010 involving requests for nuclear cardiac stress tests in the state of Delaware. All of the cases studied were handled by MedSolutions, a company that screens test requests in the state for Blue Cross/Blue Shield of Delaware and other insurers.

According to the report, “10 to 15 (percent) of requested tests appear to have been denied inappropriately. MedSolutions and the Delaware insurers denied a significant number of medically necessary nuclear stress tests.”

“It is a huge number,” Sen. John D. Rockefeller, chairman of the Senate Commerce Committee told NBC News. “I don't care if it is 5 to 2 percent, it is a huge percent. It follows a pattern that never stops with health insurance companies. It is always the bottom line. The more they say no, the more money they make.”

[OhioChick]

1. No surprise n/t

[xchrom]

2. Denying coverage is part of their business plan.

Now, imagine how that might change with a strong PO.

[Hugabear]

3. Health insurance is nothing less than legal organized crime

How ironic, everything that the rethugs claim that single-payer healthcare or a public option would do (ie rationing, denying procedures to save money) are the exact same things that private insurance companies do.

[indepat]

4. Suspect legalized racketeering in America dwarfs racketeering by organized

crime. :patriot:

[DFW]

5. Blue Cross= John Grisham's "Great Benefit."

The book was called the Rainmaker, and the evil health insurance company, "Great Benefit," had a secret
policy to deny EVERY claim. Sounds like Blue Cross to me (and we have Blue Cross).

[BadgerKid]

6. Noticed State of Illinois is trying to switch to BC/BS.

http://www.fiercehealthpayer.com/story/humana-health-alliance-lose-state-contracts/2011-04-14