Mindy dreaded having to find out if she had lung cancer. After a dark spot showed up on an image of her lung last March, the Maple Grove mother of three steeled herself for the follow-up CT scan in late May to see if the nodule had grown. But the bad news she received at the imaging center that day came from her insurer, Blue Cross Blue Shield of Minnesota, which refused to pay for the scan because it determined it wasn’t medically necessary.
“To not know if you have a cancer is an awful feeling,” said Mindy, who is using a pseudonym because her family doesn’t yet know her health status. “And then to find out the CT is denied? Wow, OK. That insurance company just played God — that’s how I felt in that moment.”
An increasing number of Minnesotans covered by Blue Cross health plans are finding that their scans and medical procedures are being denied, even though their doctor said the care is needed and would be in the Blue Cross network. The increasing trend is intentional. Dr. Craig Samitt, the company’s CEO, told the Star Tribune that Blue Cross is taking bold action to force change in a health care system that is unsustainably expensive. The action is so bold that the state hospital association this month asked the attorney general to investigate whether Blue Cross is abandoning its legal responsibilities to patients and hospitals by imposing new limits on needed care, or the payments for that care.
(snip)
Minnesota Blue Cross, a not-for-profit, outsourced its prior-authorization reviews last August to the 1,100 doctors and nurses who work for a company called eviCore, a for-profit company based in South Carolina that is owned by one of Blue Cross’ competitors, Cigna. EviCore works in all 50 states, and has more than 25 years’ experience in the field, including working with other health plans covering Minnesotans.
(snip)
The denial letter eviCore sent to Mindy contained this explanation: “Your records show that you have a known or suspected problem with your chest. They do not show results of a recent chest X-ray that were not normal. By recent, we mean during the last 60 days. Advanced imaging, detailed picture study, is not supported without these results.” When she finally got the CT scan in July, under a different insurer, the results showed three nodules instead of one.
More..
http://www.startribune.com/minnesota-blue-cross-ceo-defends-tougher-review-of-medical-procedures/513259572/
======
Before Medicare, I had an individual policy with BlueCross BlueShield (Don't know if the same) and they were great. Don't know what happened..
= new reply since forum marked as read