I manage medical labs. Part of that management is I decide which tests ordered by our providers are integrated into our EMR (electronic medical record). Some will never be "mapped," as it's called, because they're esoteric, or just too rarely ordered; it takes effort and time to do this mapping, so we pick and choose which get added.
Well at the request of a number of providers who particularly like this odd genetic-based test for cancer screening, I began the process of mapping this new item.
Part of that mapping process includes digging up something called CPT codes assigned to the testing. So I contact the company. I ask for the codes, as they're not available on their website (an oddity I could overlook). This lady tells me, "Oh the CPT codes change based on payor. You know, the insurance."
I sat there a moment, then finally found my voice. "So ... what you're telling me is based on how good someone's insurance is, your organization is picking and choosing which procedures to run, completely apart from the legal orders submitted by the provider?"
Silence for a good twenty seconds. "Uh," *whispering to someone* "I think I need to give you to my supervisor."
"That sounds great."
I'm put on hold. Five minutes later I get a guy. "Hi, I hear you have questions about our test?"
"I sure do." I repeat my question, and add, "Feel free to tell me I'm wrong. Because unlicensed individuals making medical judgments based on financial situations is antithetical to everything my organization stands for. So I'd love to be able to tell my medical directors that isn't happening."
Silence. Finally, a cleared throat. "I feel as if there's no good way to answer your question at the moment. I'll have to do some research and get back to you. May I have your phone number?"
I hung up after I gave him my number.
Here we are. This ... right here, is why for profit healthcare is an abomination.
Edit: 18 June 2020 - Still no call. I've dropped this into the lap of our compliance officer. He's talking about turning them over to CMS (the folks governing MediCal - California's version of Medicaid) for fraud. That could end them entirely if CMS decides to go after them. Good riddance.