por Diana Bradley
, Staff Writer | October 06, 2011
The Senate’s investigation report found the preauthorization procedure negatively affected patient Michael Fields and “unnecessarily delayed care for his life-threatening medical condition.” Doctors sent in a number of similar complaints from other patients regarding the stress tests.
In the end, the evidence prompted BCBSD to modify its policies so that doctors no longer needed preauthorization. BCBSD will now enter into a new pilot program with the American College of Cardiology that will automatically approve tests for patients of physicians who utilize the new program. Last month, BCBSD was also fined $325,000 by the state’s Insurance Commissioner Karen Weldin Stewart.
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According to Fisher, evidence-based, physician-developed appropriateness criteria should be used by health care providers to ensure patients have access to the correct scan at the right time. The preauthorization process is a major source of controversy as the clinical criteria insurers and their venders use for approval differ from the criteria ordering physicians follow, MITA said.
Fisher noted: “Policymakers should not place additional hurdles between patients and necessary diagnostic and screening services.”Back to HCB News