Cost a factor in stress test denial

Marketplace Staff Apr 12, 2010
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Cost a factor in stress test denial

Marketplace Staff Apr 12, 2010
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TEXT OF STORY

Stacey Vanek-Smith: If you think you’re having chest pains now, see how you feel when your insurance company won’t pay for the stress test your cardiologist orders up. That’s apparently been going on in Delaware, and tomorrow the state’s insurance commissioner takes up that issue with insurance companies. From the health desk at WHYY in Philadelphia, Kerry Grens has more.


Kerry Grens: When most people think of a stress test, they think of someone walking on a treadmill while wired to an EKG monitor. What the insurance companies denied is a more sophisticated test called a nuclear stress test. It records an image of blood flowing through the heart as the person walks.

David McCarthy, the head of nuclear cardiology at the University of Pennsylvania, says the imaging test is a reliable way to identify heart disease. But it’s also expensive and subject to pre-approval by some insurance plans. McCarthy says he’s had patients denied coverage.

David McCarthy: I mean, I think I’m ordering the test that I think is best for my patient, then to have somebody sitting behind a desk at a computer screen make a judgment is, you know, upsetting of course.

But not totally inappropriate, says Christopher Cannon. He’s a cardiologist at Brigham and Women’s Hospital, and he wrote the book Evidence Based Cardiology. He cites a recent study that found that more than 1 in 10 people who were given an imaging test didn’t meet the criteria.

Christopher Cannon: There are, you know, 13 [percent] or 14 percent that we could be trimming away.

And at $500 to $1,500 a pop, Cannon says stress tests are a good target for pre-authorization.

Cannon: We do need to allow individualization for certain patients, but this would be a very good way to try and clamp down on some costs.

And many doctors have scaled back on ordering tests as part of routine exams. Cannon says the evidence didn’t back it up.

In Philadelphia, I’m Kerry Grens for Marketplace.

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