Due to ongoing investigations of four major insurance carriers and contracted third-party MedSolutions, Delaware officials are rethinking their February decision to allow Blue Cross Blue Shield of Delaware to require pre-authorization approval from MedSolutions before state employees on the state's health insurance plan can get coverage for medical imaging tests, including nuclear stress tests.

The approval came just before reports regarding MedSolutions insurance denials surfaced. The policy, which would be effective July 1, is now being reviewed in conjunction with the insurance investigations, said Catherine Kempista, spokeswoman for Delaware's Office of Management and Budget.

The state's final announcement, coming from the Employee Benefits Committee, will be May 24, long before the investigation will be completed, Delaware Insurance Commissioner Karen Weldin Stewart told DOTmed News.
"We're in a review position and working with the leadership at Blue Cross Blue Shield to take a full look at the allegations and investigations, to come up with the best decision for the state and all of the state employees, retirees and the dependents we serve through that plan," Kempista said.

Stewart, who also sits on the committee, said her peers will look to her for guidance in making a decision in May. She said she will use all the information available from the investigations.

Because MedSolutions will have to follow guidelines from the state, which has a self-funded plan, Stewart doesn't see any reason why the state shouldn't use the company for pre-authorization reviews.

This move would save the state $1.7 million a year, according to Kempista. The state health insurance fund faces an $80 million deficit this year.

The confirmation of February's approval comes just after Stewart met with insurance carriers, shareholders, doctors, executives and legislatures to discuss the recent insurance denials for cardiac stress tests.

The first of two meetings focused solely on the insurance denials, which were brought to the commissioner's attention last month when a patient, Michael Fields, underwent open-heart surgery after being denied three times for a stress test.

There hadn't been any similar complaints in Stewart's first two years as commissioner, she said when she met with DOTmed News.

"I was surprised," she said.

Stewart points out that the media reports on the insurance denials really brought the issue to light. "It was a symptom boiling under the surface for a long time," she said.

More Industry Headlines