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.