Blue Cross denied Kelly Doran a scan during his recovery from lung cancer. So he switched his 250 em

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Blue Cross denied Kelly Doran a scan during his recovery from lung cancer. So he switched his 250 employees to HealthPartners

After Blue Cross and Blue Shield of Minnesota denied prolific Twin Cities real estate developer Kelly Doran a routine scan ordered by his doctor, the lung-cancer survivor demanded a meeting with the health plan’s CEO. Doran, who until recently was CEO of Doran Cos., soon discovered he was far from the only employee at his firm to have a medical procedure denied by Blue Cross. Blue Cross sent a junior team of account executives to meet with the developer instead, Doran said. The meeting proved unfruitful.

"The fact that doctor-prescribed procedures and tests were being denied was intolerable to me for our employees and their dependents," Doran said in an interview Wednesday. "We tried to fix it with Blue Cross and Blue Shield and they refused to change anything." Shortly after the meeting, Doran, who stepped down as CEO in May, switched his company’s 250 employees over to a HealthPartners plan. The switch cost the company an extra $70,000 a year, Doran said.

Doran’s experience seems to echo some of the concerns raised by the Minnesota Hospital Association in a 27-page letter made public Monday. The association, writing on behalf of the 141 hospital and health system members it represents, asked state officials to investigate Blue Cross for what it said was an illegal refusal to pay for essential health care procedures, among other issues. The MHA also said Blue Cross had imposed new rules governing prior authorization that have made it more difficult for patients to get coverage for a range of procedures.

Blue Cross now uses an outside, for-profit company, Evicore, to manage its prior-authorization process. The MHA claims Evicore is designed to intentionally delay care for patients and enable Blue Cross to deny payment "for as many covered services as possible."

After being denied his scan, Doran found that a number of his firm’s employees — architects, lawyers, property managers, maintenance workers and others — were also denied coverage for routine procedures. Among the procedures denied by Blue Cross, according to Doran, were a mammogram, an MRI for a Doran employee’s spouse who suffers from multiple sclerosis, and a sleep study for an employee whose doctor suspected sleep apnea. In each of the cases, the procedures were ordered by the employees’ doctors, Doran said.

Blue Cross, in response to the MHA's allegations, said the rising costs of health care have compelled the insurer to change its policies, which it says are legal.

https://www.bizjournals.com/twincities/news/2019/07/17/blue-cross-denied-kelly-doran-a-scan-during-his.html