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A agência do seguro deixa cair a régua preapproval

por Heather Mayer, DOTmed News Reporter | June 23, 2010
Blue Cross Blue Shield of Delaware (BCBS), which is under investigation by the state's insurance department, will stop requiring that doctors obtain pre-authorization approval before conducting a nuclear cardiac stress test, according to media reports and a source in the industry.

In April, Commissioner Karen Weldin Stewart asked the four companies under investigation to issue a moratorium on all pre-authorization requests while under investigation. BCBS, Aetna, Coventry Healthcare and Cigna are under investigation by the insurance department and the U.S. Senate Committee on Commerce, Science and Transportation for denying coverage of nuclear stress tests.

Aetna will lift its moratorium, which the commissioner requested be issued, for nuclear stress tests July 14.
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"Our hope is that other states and insurers will follow the lead of BCBS, avoiding needless lawsuits or other drastic measures being taken, so that cardiologists can get back to operating as per their expertise and how they best see fit to do so," said Avi Soffer, CEO of University Nuclear and Diagnostics, a nuclear stress test solutions provider, in a statement.

The investigations come after several reports in Delaware's News Journal suggested that third-party company MedSolutions was inappropriately denying nuclear stress test coverage to patients. The investigations are still underway.

BCBS did not return calls or e-mails for comment.