HMSA imaging policy still drawing doctors' ire - Hawaii News Now - KGMB and KHNL

HMSA imaging policy still drawing doctors' ire

(Image: Hawaii News Now) (Image: Hawaii News Now)
(Image: Hawaii News Now) (Image: Hawaii News Now)
HONOLULU (HawaiiNewsNow) -

Doctors are once again raising concerns about an HMSA policy that requires all advanced x-ray procedures to get pre-approval, saying the across-the-board pre-authorizations are delaying care.

"If tests are delayed a patient could suffer greatly," said Dr. Robert Ruggieri. "They could be impacted for the rest of their life. They could even die."

In December, the state's largest health insurer began requiring pre-authorization for some 3,000 doctors in its network.

Before a physican can order an MRI or CT scan, they need permission from a mainland company.

"I have to call Arizona and some doctor who's never seen a patient in 10 years and get his permission," Dr. Christopher Marsh said.

Dr. Mark Mugiishi, HMSA's chief medical officer, said that the "pre-authorization program for advanced imaging services .. .protects people from unneeded tests and unwarranted invasive services." 

He said the policy also ensures people get the right care at the right time, and helps doctors use national standards to deliver the best care to their patients.

Cardiologist John Cogan agrees.

"Health care costs are huge," he said. "The things that are requiring prior authorization are expensive. And frankly they are not always used appropriately by physician."

Lawmakers are considering holding insurers responsible if a patient is delayed tests, and the delay results in additional medical problems.

Mugiishi said the measure being debated doesn't take into account if the doctor's responsible for the delay.

One thing doctors on both sides of the debate can agree on: More dialogue with HMSA is needed.

"I think the insurance companies and the physicians should work together, try to design a system that's more efficient," Cogan said.

Ruggieri added, ""I think all they have to do is show us the evidence and we'd be glad to work with them on that. There's no need to unilaterally impose restrictions on the way we practice because it'll affect the patient outcome ultimately."

HMSA's pre-approval requirement doesn't apply to emergency situations. 

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