An industry group finds denials of medical imaging orders have doubled in four years -- and many are bogus.
While the study was done by a not-exactly-disinterested party -- the Medical Imaging & Technology Alliance (MITA) -- it does use data from the non-profit Patient Advocacy Foundation.
The study finds that private insurers, at least, seem really devoted to blocking even clearly justifiable imaging orders.
It takes "on average more than 15 phone calls, letters or emails to determine why the imaging test was being denied coverage," says MITA's blog.
MedPAC recommended prior authorization for Medicare last June as a cost-saving measure, based on evidence of widespread unneeded 
testing. Prior authorization is already widely used by private insurers and by Medicare Advantage plans,
But MITA sees it as an impediment to treatment.
"Of the 4,360 patients who contacted PAF between 2007 and 2011 for help in gaining the test they needed," CMIO reports the findings, "81% of the insurance denials for imaging procedures were due to prior authorization programs."
MITA further reports that 90% of the denied procedures that get reversed turned out to be covered by the patient's insurance. We wondered at that finding -- why else would they be reversed?
A claims expert explains:
"A fairly high number of physician practices don’t appeal denials -- either because they don’t have the know-how or resources, or because they mistakenly believe it won’t work. What this study is saying is 1.) providers should make sure to follow payer pre-authorization requirements and 2.) definitely appeal any denials because the services are covered and ultimately will be paid. Or should be."
You heard her. Insurers think you'll give up easily. But if you don't, you stand a good chance of winning.