Preauthorization denials remain under investigation in Delaware

Four months after Delaware Insurance Commissioner Karen Weldin Stewart announced an investigation into the state's insurers denying preauthorization of cardiac stress tests, it remains unclear when the inquiry will be completed.

Despite repeated requests from state Rep. Danny Short, the insurance commissioner has declined to give any update on her department's work.

She sent a letter to Short and released a separate public statement July 23 saying, "Until my Department completes its investigations, when a full and comprehensive report will be made public, this subject is closed to any further inquiry."

Short introduced legislation April 15 that would require insurers to reimburse patients for out-of-pocket expenses if a company declines to cover a test later found to have been medically necessary.

"I don't understand why these pretty simple questions are being ignored," he said in response to Stewart's July 23 statement. "I think the information I requested is something I need legislatively, and also that the public has a right to know."

Short said he was unclear about whether insurers still were honoring a preauthorization moratorium negotiated with the insurance commissioner.

Aetna spokesman Walt Cherniak Jr. said the company agreed to suspend preauthorization requirements for cardiac tests through the end of July. According to a company statement, BlueCross BlueShield of Delaware reinstated some preauthorization requirements as of July 1, but a moratorium on preauthorization for nuclear cardiac imaging tests remained in place.

Actions by Coventry Health Care and Cigna also are under investigation. Cigna stopped writing policies in Delaware in 2009.

Aetna, Coventry and the Delaware Blues all use MedSolutions, a third party, to handle utilization review. MedSolutions has denied any wrongdoing.

Meanwhile, an investigation by the U.S. Senate Committee on Commerce, Science & Transportation looking into the same issue is ongoing, committee staff said. The committee asked the Delaware Blues for information about their denials, and the plan is cooperating in the matter.