January 24, 2018

VA Health Insurance Coverage Decisions and Medically Necessary Services Act Helps Patients and Providers

Reston, VA — The Health Insurance Coverage Decisions and Medically Necessary Services Act (HB 1445) introduced in the Virginia House of Delegates will protect patients from insurer profit-driven coverage gaps and preserve patient and referring provider choice regarding where to receive care. The American College of Radiology (ACR) applauds Delegate Patrick A. Hope (D-47) for introducing the bill.

Beginning March 1, Anthem will deny coverage for virtually all medically-necessary imaging exams in Virginia if they are done in a hospital outpatient department. With only a few case-by-case exceptions, Anthem will require patients to travel up to 30 miles to get a scan in a facility where they may not know the providers. That facility may also not be able to readily share the results with their doctors if their electronic medical records systems are not connected.

“Barring patients from getting necessary imaging exams in an entire site of service like hospital outpatient departments is extreme and unprecedented. It stands in the way of efforts to better coordinate care. It takes decisions out of the hands of patients and their providers. The Anthem policy interferes with shared decision making and integrated care,” said Virginia resident and American College of Radiology Chief Executive Officer William T. Thorwarth, MD, FACR.

“The Anthem action is, at heart, a contract dispute between the nation’s largest Blue Cross Blue Shield plan and hospitals. Insurers should not be allowed to make the people of Virginia pawns in their efforts to increase profits. These are people’s lives they are messing with. It can’t be allowed to happen here,” said Delegate Hope.

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To arrange an interview with an ACR spokesperson, contact Shawn Farley at PR@acr.org or 703-869-0292.