Healthcare

Managing your health care like it or not

Anthem changes coverage policy for MRIs, CT scans at hospitals Written by Alia Paavola | August 29, 2017 

Indianapolis-based Anthem stopped covering outpatient MRIs and CT scans at hospitals without prior approval, according to the Indianapolis Business Journal.

Anthem wants its members to avoid hospital imaging services and instead opt for a cheaper alternative at a freestanding facility.

Hospitals will need to submit a precertification request for any patient receiving an MRI or CT scan at the hospital. The imaging service will only be covered at the hospital if Anthem deems the request medically necessary.

The policy took effect July 1 in Indiana, Wisconsin, Missouri and Kentucky. On Sept. 1, the policy will expand into Ohio.

The insurer has not disclosed the amount of money it expects to save or what prompted the policy change, according to the report.

What promoted the policy change? How about lowering the cost of care and hence keeping premiums under control? My wife recently had a routine preventive test as an outpatient. Before they would do it the hospital insisted on a EKG. They rolled in a cart, hooked her up for 30 seconds and billed Medicare $750. 

This is exactly the type of cost management that should be done, but also riles patients who don’t want restrictions or the insurance company interfering in their care. You can’t have it both ways folks … and you wouldn’t uder a Medicare-for-all scheme either. 

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6 replies »

  1. In the county (pop. 250,000) where I live in Washington State, the State’s Attorney General last week sued a regional hospital/health care corporation for anti-competitive practices. The corporation which runs the only hospital in the county, and many others in the Puget Sound area, bought out a multi-practice doctor’s practice (with 50 physicians) and a medical imaging practice.

    The corporation claims they are seeking to spread costs, increase patients and obtain increased clout with insurance companies. The Attorney General, who is widely believed to be running for Governor someday soon, claims the predatory practice of the corporation was intended to stifle competition resulting in higher health care costs. Seems to me both are true.

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    • We need competition among health care providers assuming patients care, but competition among insurers is typically counterproductive because of the process of negotiating fees and the need for leverage.

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    • In my county in NJ, the hospital chain has bought out a very large percentage of the doctor’s offices, controls both hospitals in the county and just bought out my town’s non-profit ambulance service. The ambulance service had a for profit transport service division which it also bought out. It is clear that they wanted to set the rate for Medicare and Medicaid rates in the county.

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  2. Did either of you feel the urge to shop around? I know I would not have dreamed such a difference plus I am already at the hospital. I also don’t understand why Medicare short changed the doctor by another $4.
    For less than $750 you can buy a complete 12 lead EKG machine online. Did you get to take it home? The hospital pricing must be trying to cover their charity loses. No wonder insurance companies do not want you to go to a hospital. There must be a major flaw in the law involving charity care too.

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  3. Wow! What kind of inconsistency is this? I get a 12-lead EKG twice a year at cardiologist’s office. Round numbers: Initial charge by doctor, $49; Medicare allowed $19; Medicare paid $15.

    Sent from my iPhone

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