What Do You Mean It's Not Covered: One Insurance Company Didn't Recognize MRI

At the time the MRI was done on Griffis, Blue Cross did not recognize the use of MRIs for diagnosing cancer of the prostate "as having scientifically established medical value and [as] being in accordance with generally accepted standards of medical practice." The use of MRIs for diagnosing conditions of the brain, spine, and limbs, however, was recognized by Blue Cross. Griffis sued Blue Cross, seeking to recover damages for Blue Cross' refusal to pay a claim under his medical insurance policy. He claimed breach of contract and the tort of bad faith refusal to pay an insurance claim. Dr. Patrick Ryce, director of Blue Cross' medical department, said that it was his decision to place MRIs of the prostate on the company's list of experimental or investigative procedures. His decision was based on information that he had received in consultations with Blue Cross' medical review committee, which consisted of practicing physicians who were not employed by Blue Cross, as well as on information that he had received from practicing radiologists who were experts in their field and had hands-on experience with MRIs. Ryce also testified that he had reviewed various medical journals regarding new treatments and tests and that he had considered the recommendation of the National Blue Cross and Blue Shield Association, a central organization that reviews new medical procedures and disseminates information to the approximately 78 Blue Cross and Blue Shield plans throughout the country. Ryce explained that Blue Cross' list of experimental or investigative procedures was reevaluated continuously and that the list was revised approximately every six to eight weeks to reflect the technological advances that had been made in various procedures.