The ultrasound tests are non-invasive and relatively inexpensive, but physicians cited in the report say they’ve had to wait between five to 40 minutes for pre-approval. If approval is denied, physicians then have to resort to the next step of peer-to-peer review. Physicians say the process is an administrative burden they are not reimbursed for, and there is nothing to offset added costs of the time-consuming process.
Four state chapters of National Health Organizations have co-signed a letter asking BCBS North Carolina to not require pre-approval for echocardiograms, citing “a substantial hardship on both patients and physicians, with little benefit to BCBS N.C. and its subscribers,” according to the report.
In the report, BCBS N.C. said it will not change its policy and said national studies have shown echos are inappropriately used 15 percent of the time. The payor also said its research shows that 70 to 80 percent of the time, pre-approvals take an average of four to five minutes.
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