September 15, 2017

Anthem Restrictive Imaging Policy Raises Concerns

Anthem, the nation’s largest Blue Cross Blue Shield health insurance company, recently implemented a new Imaging Clinical Site of Care program in select states. The program, administered by Anthem’s subsidiary, AIM Specialty Health, requires a new level of preauthorization for advanced diagnostic imaging services, based on their site of service.

The American College of Radiology (ACR) is gravely concerned about Anthem’s recent decision to no longer allow advanced imaging to be performed in hospital outpatient settings unless it qualifies for an exception under a newly published policy. It was implemented in Colorado, Indiana, Kentucky, Missouri and Wisconsin on July 1, and it was extended to Ohio, Colorado, Nevada, Georgia and New York on Sept. 1. The ACR anticipates Anthem’s policy will be ultimately applied to all 14 states where it operates.

On Nov. 15, Anthem will also implement a policy in Missouri, Ohio and Kentucky where it will conduct retroactive reviews of MRI and/or CT services performed in emergency departments and will deny claims when it determines the imaging procedures are not truly related to emergency situations.

The College is especially concerned about how Anthem’s policy will affect timely patient access to advanced diagnostic imaging services. Prior authorization denials may potentially negatively impact rural patients because their hospitals’ outpatient departments may be the primary points of care for imaging services in their communities. The policy could also negatively impact indigent, inner city patients who may find it more difficult to gain access to freestanding facilities than hospital outpatient departments.

Site-of-service decisions based solely on imaging costs also negatively impact patients by ignoring pre-existing relationships between referring physicians and radiologists. These relationships between ordering and rendering physicians are largely based on quality of care and the skills of the radiologist who perform and interprets the imaging study.

The ACR has reached out to Anthem to relay our concerns and to begin a dialog with the insurer. Additionally, the College issued a statement on the policy.

For more information, contact the Katie Keysor at