Health Insurance Companies Cut Back On Medical Tests - Does This Help Or Hurt Patients?

The Associated Press is running a story today in papers across the country, documenting cutbacks health insurance companies are making in the number of medical tests they approve. Actually, the carriers are requiring pre-approval for more and more tests, which has the effect of cutting back on the total number. The insurance companies say this is for the protection of the patients (to reduce unnecessary exposure to radiation), but doctors say patients are endangered because they're not getting sufficient testing before diagnoses are made. Here are excerpts from the story:

Insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns. And some doctors agree that there’s emerging evidence that these scans are being over-prescribed.

“Costs are soaring in this area, quality concerns are mounting, and safety concerns are mounting,” said Karen Ignagni, the chief executive of the trade group America’s Health Insurance Plan.

Health insurers are requiring more preauthorizations before patients can have these scans, and setting other restrictions including mandating that the imaging equipment and medical staff be credentialed in advance.

Insurers fear that some patients are being exposed to dangerous radiation levels from having repeated CT and PET scans, which use many times the radiation of a regular chest X-ray. Sometimes, scans are repeated because the first ones were not done properly because of outdated equipment or poorly trained technicians.

But doctors say that the bigger problem with medical imaging tests is the insurance red tape needed to get them.

“Is this a preauthorization process, or are these (insurance) companies practicing medicine?” asks Dr. Arl Van Moore, the board chairman at the American College of Radiology, the specialists in medical imaging.

Moore cited another reason for increasing costs: Doctors sometimes order a diagnostic test that doesn’t need preauthorization - even if it provides less-helpful information than the one they prefer - then try to get approval for a more advanced test if the first one shows that it’s needed.

Worse yet, sometimes patients end up getting a riskier, more invasive test than what they really need, Hendel said. For example, cardiologists wanting to assess blood flow and blockages inside a patient’s heart arteries would prefer a nuclear cardiology test. With that, a small amount of a radioactive substance is injected in the blood and tracked using a camera.

Some doctors will instead order a cardiac catheterization, which doesn’t require advance authorization, Hendel said. But that involves threading a catheter through a blood vessel up into the patient’s heart - and carries a 10-times higher risk of complications such as a heart attack or stroke, he said.