September 29, 2017

Concerns Grow for Anthem MRI/CT Payment Policy

Anthem’s recent policy change, which applies a new level of pre-authorization to diagnostic imaging performed in hospital outpatient settings, is drawing more attention from health care observers and the medical community.

The controversial policy, enacted in several states, drastically alters where and how patients receive care. In July, Anthem initiated a rollout of a policy in nine states that revamps pre-authorization for all diagnostic imaging (CTs and MRIs) in hospitals.

Since Anthem is a nationwide insurer, it is reasonable to anticipate these policies will soon be rolled out across the country. The “Imaging Clinical Site of Care” program, administered by Anthem’s wholly owned subsidiary, AIM Specialty Health, requires physicians to submit an additional “level of care” request for outpatient imaging services performed at a hospital. AIM will then determine if it is medically necessary to perform the advanced imaging procedure in the hospital outpatient setting.

Hospitals, physicians and patients are voicing their concerns as is evidenced by increased media coverage:

Kaiser Health News: Need an MRI? Anthem Directs Most Outpatients to Independent Centers (9/26/17 )

St. Louis Letters to the Editor: Anthem's change in policy will hinder access for patients

The American College of Radiology has expressed concern about the policy, which we are closely monitoring. Look for future coverage and commentary from the College in Advocacy in Action eNews.