Health insurer does about-face on concussion tests
A well-proven and FDA-approved concussion testing and treatment protocol called ImPACT is suddenly, and seemingly without proper explanation, not covered by Highmark BCBS, one of Delaware's key insurance companies. My medical colleagues and I want to know why.
Schools and colleges across the country use the ImPACT testing protocol to create baseline tests for comparison before an athletic season which can then be compared to post-injury tests conducted in a follow-up at a physicians' office. The physician can then compare the results pre-injury to post-injury to assess the severity of the concussion.
One of only two FDA-approved concussion testing tools available today, this easy-to-use and highly effective system has been successfully employed by more than 75 percent of American NCAA sports programs as well as approximately the same number of junior and senior high schools. We have more than 70 million results in our database, and have been backed by close to 300 journal articles since 1998.
ImPACT works. It's proven. It's approved by almost all major insurers in the country. Yet, despite more than a decade of success and approval by almost all other insurance companies, the testing is, as of last year, suddenly labeled "experimental" by Highmark Blue Cross Blue Shield. The insurer refuses to compensate physicians so they can administer and diagnose concussions and follow patients to full recovery.
ImPACT is a fraction of the price of the only other FDA-approved concussion testing tool in the United States. Additionally, less than 10 percent of any MAC concussion patients require additional costly CT scans or MRIs. These tools are not normally required to diagnose concussion and are only utilized to rule out bleeding or tumors.
Again, Highmark BCBS is the only insurer we know of refusing to cover this critical testing. All other BCBS plans across the country cover this test. It doesn't escape our knowledge that Highmark is involved in an unrelated, ongoing legal battle with University of Pittsburgh Medical Center, coincidentally where ImPACT testing was created. Therefore, the sudden about-face refusal to approve ImPACT testing last year would appear to be related. Our patients should not become collateral damage in what appears to be a grudge match between Highmark and UPMC.
Second Impact Syndrome can result when initial concussions aren't treated correctly, leading to severe disability or even death in our talented, young athletes. ImPACT testing is the only tool we have to objectively diagnose and follow a concussion to full recovery to prevent SIS. Our grievance is not about money; it is about saving lives.
I have reached out repeatedly to Highmark as well as local government offices and insurance boards, even testifying before Highmark's Neuroscience Committee, to no avail. Professional and college athletes from all over America fly to Pittsburgh, Pa., for concussion care at UPMC. Why can't our patients continue to benefit from this well-proven technology?