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Health Team

Blue Cross approval policy gives cardiologists heartburn

Posted February 23, 2012 5:52 p.m. EST
Updated February 23, 2012 6:46 p.m. EST

— Cardiologists across the state are lining up to oppose a new Blue Cross Blue Shield of North Carolina policy that requires patients to get approval from the insurer before getting an echocardiogram.

Dr. Jenie Comives, Blue Cross' senior medical director, said multiple studies have shown that 15 percent of cardiac echo tests are ordered inappropriately.

"We spent $17.5 million last year on these tests," Comives said Thursday. "Our goal is not to have a high denial rate. Our goal is to have everybody using and ordering these appropriately."

Since the prior authorization policy went into effect Jan. 15, Blue Cross says, doctors statewide have ordered about 2,000 cardiac echoes. Three-quarters of those were immediately approved, and the rest were delayed so more information could be submitted.

Eighty-five cardiac echoes were denied, but the insurer says 51 of those patients were given a different test.

Dr. Jack Newman and other cardiologists contend that Blue Cross is getting between patients and their doctors.

"With so much oversight being done, it's impacting patient care," said Newman, part of the Raleigh Cardiology practice.

He called cardiac echo tests "as basic as a stethoscope" and said the tests are relatively inexpensive and pose few safety risks.

"I had a patient a couple weeks ago who drove two hours to see me," he said. "(Because of the new policy,) she has to come back for a stress test – another two-hour drive back and forth."

Newman said he fears other insurance companies will institute similar prior approval policies.

"Of course they'd prefer not to have to go through an authorization process. I don't blame them for that," Comives said. "Right now, this is the only tool we have available to ensure our members are in fact getting the right test."

Still, Blue Cross is discussing other possible alternatives with the American College of Cardiology, she said.