Nightly News | April 15, 2011
>>> we're back now here tonight with an nbc news investigation about your money and your life. to hold the line on soaring health costs and unnecessary expensive medical tests , many health insurance companies now require preapproval, as you know, for some tests. a new senate report out today underscores what a lot of us already know, some americans have been wrongly denied tests they urgently need. it has almost cost at least one father his life. here with the story, our senior investigative correspondent, lisa myers .
>> ready? coming right to you.
>> reporter: a little over a year ago, 46-year-old mike fields went to the doctor complaining of pressure in his chest, extreme fatigue, shortness of breath.
>> i had a real bad feeling there was something wrong, you know. something bad.
>> reporter: his doctor sent him to get a nuclear cardiac stress test . radioactive material is injected into the heart to assess blood flow . but fields ' insurance company , blue cross blue shield of delaware , denied approval of the test, three times.
>> what were you told?
>> i was told -- the letter stated that they didn't deem it necessary.
>> reporter: recorded calls show fields ' doctor's staff pleaded for approval.
>> i'm at a total loss. this guy needs a stress test or he's gonna drop dead .
>> reporter: finally fields ' exasperated doctor sent him to the hospital where a doctor found a key blood vessel almost completely blocked.
>> is this considered a serious heart problem ?
>> oh, yeah. this is about as serious as you get. if this closes, your heart is basically gone.
>> reporter: the next day fields had an emergency quadruple heart bypass .
>> if mike fields had not come to this hospital?
>> he wouldn't be alive today, guaranteed.
>> reporter: the decision to deny the test actually was made by a company called med solutions hired by the insurer to preapprove medical tests . the company works for insurers nationwide and both said it can cut costs 25% to 30%. today a senate investigation of med solutions' cases in delaware found some denials were warranted, but that a significant number of medically necessary nuclear stress tests were denied inappropriately. about 10% to 15% of all tests. senator jay rockefeller says it's an industry strategy.
>> it's absolutely deliberate. it's what they have always done. the more they say no, the more money they make.
>> reporter: in fact, delaware 's insurance commissioner reported today that under the contract, med solutions' fees were to be cut if it didn't save blue cross 20% or more. med solutions disputes the senate's findings and argues that cardiologists overuse these tests, often because they have a financial interest. the company says its guidelines ensure that patients receive the right tests at the right time. at no point ever is any criteria considered that doesn't put quality and safety patient care first. both med solutions and blue cross say they can't comment on the fields case because of privacy laws . blue cross says it has since changed procedures and no longer requires preapproval of nuclear stress tests. machines for these tests are made by philips, siemens and general electric , a part owner of nbc universal . fields still has not gotten over the desperation he felt last year.
>> i knew something was wrong with me, i knew it. i didn't know what to do.
>> reporter: but he considers himself lucky to be alive and treasures time with his son even more.
>> reporter: lisa myers , nbc news, newark, delaware .