While cervical disc pathology can unquestionably produce radiculopathy, many patients presenting with arm pain, paresthesia or perceived weakness do not exhibit the clinical behavior of true nerve-root compromise. In these cases, failure to differentiate the primary pain generator may lead to unnecessary spinal injections, nerve ablation procedures or surgical consultation despite limited likelihood of benefit.
Empire Blue Cross/Blue Shield Fined $1.1 Million
Empire Blue Cross/Blue Shield, the largest nonprofit health insurer in New York, has been fined $1.1 million by the state's insurance regulators.
Among other things, Empire was charged with denying health coverage to certain patients:
Denying advanced chemotherapy and bone marrow treatments to some women with breast cancer, while approving treatments for others.The $1.1 million fine is the largest ever levied against a health insurer in the state of New York. Since the time of these infractions, Empire has seen the number of policyholders reduced by approximately 50 percent (to 4.8 million).Denying in vitro fertilization procedures to some while approving the procedure for others.
Paying physical therapists for certain procedures, but denying payment to chiropractors for the identical procedures.
While Empire has positioned a new management team to recoup its losses, the fine should send a clear message to other carriers. The New York Insurance Department is expected to keep a close watch on Empire over the next three years.