Blue Plans Medical Necessity Program

Abstract

ADOLPH et al (JAMA 241:799-800,1979), in their COMMENTARY, protest the policy of the Blue Cross and Blue Shield associations as it applies to phonocardiography, pulse tracings, and apex cardiograms. The writers fear that patients will be denied these procedures when they might be of specific benefit to the patient. The policy they protest denies nothing. It recommends to Blue Cross and Blue Shield plans that payment be made only when the claim is accompanied by a report from the physician stating the indications in the given case. There is nothing in the policy that recommends abandonment of phonocardiography, as implied in the title, and nothing that denies any of the procedures when indicated. Nine of the 11 cardiologists protesting the policy might protest the need to submit a claim by report, but there is no justification for the implication that the policy recommended to the associations by the American College