October 20, 2017

State Chapters Push Back Against Anthem Policy

More stakeholders are voicing concerns over a controversial clinical imaging site-of-care program administered by Anthem subsidiary, AIM Specialty Health, for its individual and employer-sponsored members in fully insured programs.

Under the new policy, Anthem will no longer pay for MRI or CT scans performed at hospitals unless an AIM review of the imaging order finds it is medically necessary to perform the procedures at a hospital. The insurer began phasing in these changes in July and expects to finish implementation by March 2018.

As of October 18, American College of Radiology (ACR) chapters in at least six affected states (California, Colorado, Georgia, Indiana, Ohio and New York) had written to their respective state insurance commissioners to express concerns with Anthem’s Policy. State chapters in Virginia and Missouri are preparing letters.

In aggressive contract negotiation maneuvers with hospitals, Anthem is treating patients and ordering physicians as pawns placed unnecessarily in the middle of such talks. Policies focused on site-of-service issues could turn medical imaging reimbursement into a race to the bottom with significant consequences for all imaging providers, regardless of practice setting.

See ACR resources for those in impacted states can use to express to lawmakers, regulators, government officials and the media how these policies can adversely affect patients.