Health insurers in Delaware suspend "pre- authorization"

    The Delaware insurance commissioner is investigating complaints that insurers denied coverage for certain types of stress tests, even though doctors say patients needed them.

    Delaware’s insurance commissioner is asking for input from patients who have been denied coverage for medical procedures by their insurance company. Several complaints from people who were denied coverage for stress tests have sparked an investigation by the commissioner — and the US Senate.

    Some insurance plans require pre-authorization for expensive procedures, such as stress tests that include heart imaging. Approvals are used to keep costs down and prevent unnecessary exams.

    But the process seemed to go too far, says David Ramos, a cardiologist from Dover. He says patients at his practice were being denied daily.

    Ramos: We unfortunately had patients that have had bad outcomes because testing was delayed or denied. And even the patients that don’t have an outcome issue, we’ve had surgeries delayed where the patient was scheduled for surgery a given day, now they get put off for a few weeks.

    Delaware’s insurance commissioner and Senator Jay Rockefeller from West Virginia have asked insurers to provide data on their pre-authorization procedures. Since the investigations began, four insurance companies have suspended denials.

    Commissioner Karen Weldin Stewart says, for the time being, patients will have an easier time getting the tests. But there might be consequences later on.

    Weldin: For the most part the procedures are going forward, which would mean that the safeguards, the cost containments that might have been in place, are not in place right now so that could have an impact on premiums. We’ll have to keep an eye on that for next year.

    The insurance commissioner says she’s received only a few complaints from patients, and would like to receive more. The US Senate Commerce Committee has taken up its own investigation of the Delaware insurance companies. Stewart says she expects to have information on the frequency of denials in the next few weeks.

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