Blue Cross Blue Shield of Delaware is in trouble for denying customers coverage for certain kinds of high-tech imaging tests. They have been using a company called MedSolutions in order to lower their costs. Delaware’s Department of Insurance says that Blue Cross Blue Shield of Delaware has broken the law by refusing to pay for these kinds of tests.
It seems to me that whenever I read a news article that involves Blue Cross Blue Shield, or any combination of that name, it is not a story praising the good things that the insurance company has done. It doesn’t even seem to matter what state the particular portion of Blue Cross Blue Shield happens to be in, either. Here is a quick recap, in case you haven’t been following along.
Last year, the federal government sued Blue Cross Blue Shield of Michigan because the insurance company had been engaging in practices that prevented competition between insurance companies. Those same practices would increase the cost of insurance for consumers. In February of this year, Blue Cross Blue Shield of Illinois was required to pay a $25 million settlement for fraud because it was denying coverage to sick children that required nursing care. Instead of paying for those claims, it fraudulently shifted those claims to Illinois Medicaid program. And, let’s not forget the drama caused by Blue Cross Blue Shield of California when they wanted to raise the cost of premiums by 59%. This kind of news makes me feel as though Blue Cross Blue Shield isn’t a very honest insurance company.
Now, Blue Cross Blue Shield of Delaware is in trouble for breaking the law, according to Delaware’s Department of Insurance. The insurance company signed a contract with a company called MedSolutions in July of 2009. The contract guaranteed Blue Cross Blue Shield that MedSolutions would save the insurance company money, by denying coverage for high-imaging tests. One of those kinds of tests is called a nuclear cardiac exam. That test allows doctors to diagnose artery blockages.
According to a report, MedSolutions denied 27% of requests to pay for nuclear stress tests. Blue Cross Blue Shield uses a pre-authorization program which forces doctors to prove that a test was needed before the insurance company would pay for it. The insurance company is using standards that are stricter than those recommended by the American College of Cardiology. At this time, it is unknown if the insurance company will be fined, or if other penalties will be imposed on it.
Image by Patrick J. Lynch on Flickr