To the Editor.—
In the article by Woolf and Kamerow,1 entitled "Testing for Uncommon Conditions" and published in the December 1990 issue of the Archives, one important reason for doing "chem profiles" was omitted. This is the fact that, at least in Massachusetts, some insurance companies will not pay for more than three separate tests, because it is cheaper to order a whole chemistry profile. Thus if, as is commonly the case, one has a hypertensive patient taking diuretics and wishes to follow the creatinine, electrolyte, glucose, and uric acid levels, one is not permitted to order just those tests— one must order the whole chemistry battery and then chase the inevitable elevated levels of alanine transaminase or alkaline phosphatase. I wonder if the insurance companies have taken into account the expense of tracking down these falsely abnormal values in setting their policy.