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Senate Finds Screening Company For Delaware BC/BS Denied 10-15% Of Needed Tests

If you ever experience something like this, call the insurance company and demand to speak to a supervisor: "I'm filing a complaint with the insurance commission and also with my congressman, and I want to make sure I have the correct details

If you ever experience something like this, call the insurance company and demand to speak to a supervisor: "I'm filing a complaint with the insurance commission and also with my congressman, and I want to make sure I have the correct details for why you're refusing me a necessary medical test as ordered by my physician. Oh, and I want to make sure I spell your name right."

While your state insurance commission is possibly in the pocket of the industry, they do at least investigate these cases, and the insurance companies just don't want the hassle. It may not always work, but it's worked for me so far for the five or six times I did it:

“I gotta tell you Kathy, I can’t keep living like this,” said Michael Fields, 46, who was experiencing tightness in his chest, numbness in an arm and light-headedness as he begged the voice at the other end of the line for help. “It’s been going on for weeks. I don’t know what else to do. I mean you know, I’m trapped here.”

“Alright, let me put you back on hold,” came the reply.

Fields, who lives with his wife and son in Elkton, Md., was not speaking with a 911 operator. He was calling a representative from his insurance provider, Blue Cross/ Blue Shield of Delaware, and he was about to find out that for the third time he was being denied a crucial test to determine if he had coronary artery disease — a nuclear cardiac stress test.

A 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.”

Michael Fields was one of those found to have been wrongly denied.

When Fields first complained about his symptoms over a year ago, his physician sent him to get a stress test. The request was denied by Blue Cross Blue Shield, and denied again after two appeals by the physician. Finally, his doctor sent him to the hospital, where cardiologists found that a key blood vessel to his heart was almost completely blocked.

The next day Fields had an emergency quadruple heart bypass.

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