October 25, 2018

Massachusetts BCBS Plans Tiered Cost Sharing for Imaging

Blue Cross Blue Shield of Massachusetts (BCBS MA) recently announced a program that will give preference to freestanding imaging centers over hospital-based imaging by way of split-level cost-sharing for X-ray and advanced imaging services.

The program, which will become effective January 1, 2019, will apply to all Merged Market medical plans except Blue Options plans, Blue Select plans, Connector plans and plans with Hospital Choice Cost Sharing.

After a patient’s deductible is met, lower copayments and co-insurance will apply to imaging services received at freestanding centers, and higher copayments will be required for imaging performed in hospital settings. BCBS MA believes this program will promote use of low cost, high-quality providers.

The American College of Radiology (ACR) has concerns about the new policy’s effect on patient access to care, particularly where few freestanding center options are available. We plan to reach out to the insurer to discuss these matters.

For questions about this new payer policy, please contact Katie Keysor, ACR senior director, economics and health policy, at kkeysor@acr.org.