A Twin Cities real estate developer has taken on Blue Cross Blue Shield of Minnesota, one of the largest health insurers in the state. A hospital group has asked for state investigations into the insurer. Has Blue Cross run afoul of the law?
For seven years, Minneapolis-area real estate developer Kelly Doran had chosen Blue Cross Blue Shield of Minnesota as his company’s health insurance provider.
The two had a good working relationship, Doran says.
“I never had any issues with them,” he says.
But that changed around five months ago, when his wife was denied an MRI. She had gone to urgent care for problems with her back and neck, and the provider ordered an MRI to take a closer look at her spine and discs. The scan required “prior authorization” – which means the provider had to contact BCBS and secure approval before going ahead with the procedure.
So, the provider sent in a prior authorization request form. BCBS denied the procedure.
The reason? The urgent care provider had checked an incorrect box. At the time, though, Doran was given a denial with no explanation, he says.
“She had to go to her normal doctor ultimately – days later, after going through more pain,” Doran says.
Not long afterwards, Doran himself had a similar experience. A lung cancer survivor, Doran had been instructed by his doctor to get CT scans of his lungs every six months. He had been going in with no issue since early 2017, but the insurer denied a recent scan without warning, he says.
The issue proved to be yet another administrative kerfuffle, and Doran eventually got the scan. But he later found out that several employees at his company had been having similar issues with Blue Cross. After an unsuccessful attempt to meet with the insurer’s CEO, Doran decided to switch to HealthPartners – a move that cost him $70,000 because he made the switch mid-year, he says.