This post was contributed by ACR Executive Vice President of Government Relations and Health Policy Cynthia Moran.
Anthem, the nation’s largest Blue Cross Blue Shield health insurance company, has stopped covering patients in 9 states for MRI and CT scans performed in hospital outpatient settings — unless the exam qualifies for an “exception.” Anthem will likely extend this plan to all 14 states in which it operates.
On Nov. 15, Anthem will start retroactive reviews of MRI and/or CT exams done in emergency departments in Missouri, Ohio and Kentucky. Anthem will deny imaging claims if it decides the case was not truly an emergency.
These Anthem policies place patients and doctors in the middle of a payment dispute between Blue Cross Blue Shield’s for-profit entity and hospitals. This adversely impacts patient care, disrupts the patient-physician relationship and worsens hospital bureaucracy — ultimately hurting patient care.
The American College of Radiology (ACR) is opposing this Anthem effort. Regardless of whether you practice in an office setting or hospital, you should oppose this Anthem policy which makes imaging a commodity going to the lowest bidder.
The College has created a toolkit of materials to help members in affected states push back against this blatant cost-cutting move. Please use these resources to help the ACR help us end this misguided Anthem effort.
I also urge you to contact the ACR with any specific example of how patient care is being negatively impacted in your department/hospital by the Anthem outpatient imaging policy.
Please email those examples to us at firstname.lastname@example.org.
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