UNITEDHEALTH: Some Doctors Need to Justify Imaging Tests
A third loophole has emerged in UnitedHealth Group's policy to allow doctors the final say on care decisions. Doctors in New York, New Jersey, Connecticut and Ohio still must justify their reasoning before running computerized tomography tests (CT scans) and magnetic resonance imaging (MRIs). The Wall Street Journal reports that the exception exists because UnitedHealth remains in a contract with American Imaging Management Inc., the company that makes all imaging decisions in those states. A UnitedHealth spokesperson said it is possible that more exceptions to the new policy could emerge "because every market has some contracts that delegate the management of some kind of medical service." Other exceptions include mental health benefits and prescriptions. In the meantime, some doctors are crying foul. David Habif, a New Jersey radiologist, said, "It's another triumph of marketing over fact. It just goes to show, believe half of what you see and none of what you hear." Through a press release, the Medical Society of New Jersey has accused UnitedHealth of "dealing in bad faith." Craig Keyes, chief medical officer for UnitedHealth's New York, New Jersey and Connecticut office, said "much of the anger was a result of a misunderstanding and an error generated by his own office." A letter he signed and sent out in October indicated that doctors still had to receive permission from UnitedHealth before ordering imaging tests. Doctors actually must call the contracting companies and justify their decisions, but UnitedHealth approval is no longer needed (Gentry, 12/22).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.