Physicians call Anthem's new imaging reimbursement guidelines 'arbitrary and unwise': 5 takeaways

The American College of Radiology, a Reston, Va.-based professional medical society, argued Anthem's new imaging policy for hospital-based MRI and CT scans is "arbitrary and unwise," according to a Richmond Times-Dispatch report.

Here are five takeaways.

1. On July 1, Indianapolis-based Anthem ended coverage of hospital-based MRIs and CT scans without prior approval in Indiana, Kentucky, Missouri and Wisconsin, and expanded the policy to Ohio Sept. 1. Hospitals will need to submit a precertification request for any patient receiving an MRI or CT scan at the facility, and in most cases the imaging service will only be covered at the hospital if Anthem deems the request medically necessary, among other factors.

2. The payer will expand the policy to California, Connecticut, Maine and Virginia March 1, according to the report. The widespread policy change aims to incentivize the use of cheaper alternatives at freestanding facilities.

3. Virginia Health Information, a nonprofit organization providing health information to businesses and consumers, said an MRI of a knee provided at a physician's office cost $597 in 2015. Comparatively, the same scan cost $1,678 at a hospital the same year.

4. While costs for MRIs and CT scans are generally higher in hospital settings, Julian Walker, a spokesperson for the Virginia Hospital & Healthcare Association, told Richmond Times-Dispatch, "Decisions about advanced imaging tests that patients need to diagnose and treat an illness or injury should be made with patient interests in mind. Decisions by insurers to restrict where patients are permitted to receive a necessary medical procedure fail to meet that standard."

5. A Bon Secours Richmond (Va.) Health System spokesperson told the publication the system is talking with Anthem to understand possible implications of the policy. The spokesperson added, "Bon Secours firmly believes the selection of the proper setting for imaging services should be a medical decision, rather than a business decision."

To learn more about the policy change, read Anthem's FAQ.  

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