The Wall Street Journal today has a story about insurance companies hiring "outside firms to help rein in the skyrocketing costs of imaging scans like MRIs." Included in the story is a Dallas man, S. Blaine Porter, who was treated in 2006 for aggressive lymphoma. Porter says his insurer, Blue Cross and Blue Shield of Texas, insisted upon delaying his necessary positron emission tomography scans from once every three months, per his oncologist's orders, to "four months or more between PETs." As you might imagine from Porter's inclusion in the WSJ piece, something very, very bad happened because of the delay, according to Baylor University Medical Center oncologist Edward Agura.
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In July 2007, Mr. Porter had a seizure that turned out to be caused by a new tumor, this one between the two lobes of his brain. Dr. Agura says he believes that the new brain tumor might have been detected earlier if the scans had taken place promptly every three months. "Every time we scanned him, we had to go through a lengthy approval process," he says. "Delays in approval lead to cancers coming back and not being detected."
Blue Cross and Blue Shield of Texas deny denying the requests. --Robert Wilonsky