Saturday, April 02, 2005

The Insurance Industry and how they misuse medical tests

A patient of mine recently decided to go in for a life insurance policy. Because this was a large value policy, the insurance company wanted her to go in for various tests, including an exercise stress test. The rationale for this testing is to allow them to identify clients who are at increased risk for dying, so that they can distribute the risk, and increase the premium they charge these clients. She was a healthy 42 year old woman; and her stress test had some ST segment depression in the inferior leads. The doctor who did the stress test then chose to report this as a "mildly positive" stress test. Based on this report, the company then refused to issue her a policy ! Unfortunately, as with most companies which are bureaucratic and autocratic, trying to explain to them that the medical literature proves that ST segment changes during exercise in women do not reflect an increased risk of dying , was like banging your head against a brick wall. They just refused to listen ! The solutions they offered in order to allow the client to prove that she had a clean bill of health were mind-boggling. The client could do a thallium stress test or a CT angio to prove that she did not have coronary artery disease ! They told her of another client who had even gone ahead and done a coronary angio to prove his arteries were healthy, in order to qualify for the policy ! This is a travesty of all medical testing, and I feel doctors should put their foot down, and prevent insurance companies from misusing medical technology.
An excellent article offers much better alternatives.
"The biggest problems posed by our continuing “love affair” with stress testing relate to the enormous delays and tremendous expense we must bear to indulge these misallocated “affections!”

Will insurance companies wake up and listen ?

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