Anthem Axes Payments For Outpatient Imaging at Hospitals

Anthem recently announced a new imaging payment policy, which excludes payments to hospitals for outpatient MRIs and CT scans.

The new program, known as the Imaging Clinical Site of Care program, will require outpatient imaging which is considered to not be clinically necessary to be performed at a freestanding imaging center in 13 of the 14 states that Anthem covers patients. Anthem will review all prior authorizations for imaging to determine if a scan is clinically necessary; in the event that a request is denied, Anthem will not provide payment for the imaging. The only state without the program in effect by March 2018 will be New Hampshire. 

Anthem hopes the program will push patients towards less expensive imaging centers, as opposed to the expensive in-house imaging at hospitals. 

“Anthem’s primary concern is to provide access to quality and safe health care for our affiliated health plan members,” an Anthem spokesperson said. “We are also committed to reducing overall medical cost where possible when the safety of the member is not put at risk.”

The company also noted that moving the imaging procedures to freestanding imaging centers would save patients between $1000 to $200 in cost-sharing payments. —David Costill