P.I.S.S.D. — Personal Injury, Social Security Disability. Dallas Texas Lawyers

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ones were not done properly because of outdated equipment or poorly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.