No More Hospital-Based Imaging Says Anthem

Nick McLaughlin, Ridiculously Nice Sales

The Patient Experience is #1 on our list of priorities. It seems that may not be the case for Indianapolis-based Blues giant, Anthem, who implemented a new policy this summer saying that they will no longer pay for MRIs or CT scans delivered at hospitals, unless a review finds it was medically necessary to perform the scan at a hospital. The states effected are Indiana, Kentucky, Missouri, Wisconsin, Colorado, Georgia, Nevada, New York, and Ohio.

Anthem’s hope is that the policy allows them to keep premiums low, and give patients with High Deductible Health Plans an opportunity to save hundreds of dollars to go to a free-standing imaging center. The trouble with that explanation is that patients already have that option. Those who want to take advantage of it can seek lower-cost imaging services, but Anthem’s broad brush solution of not paying for hospital-based imaging at best limits patients from seeking the services they want, where they want, and at worst sticks their patients who are not familiar with this policy with even larger, unexpected bills.

What does this mean for Americollect clients?

Some patients with the resources and ability to deal with the hassle of this policy will likely seek outpatient-imaging services outside of the hospital setting. This will likely deal a significant blow to an often profitable service line, and hurt hospitals’ ability to offer other important services that operate at a loss. Additionally, there will be patients who go to the hospital for care, receive their normal service there, and wind up with a surprise bill that is not covered by Anthem because of this policy. Many of these accounts will wind up in bad debt, the patients will be furious that Anthem did not pay them, and many will refuse to pay the balances themselves. This is a lose-lose situation all the way around.

What can you do?

As if you didn’t have enough hoops to jump through already, here’s another one: figuring out how to prove medical necessity for Anthem’s imaging patients. There is a lot on the line with this one, so figuring out what qualifies as “medically necessary to perform the scans at a hospital” would be my greatest recommendation. Next, for yours and the patients’ sake, try to run all out-patient services through an eligibility check prior to providing the service. I hate that this now has to be done down the services that are provided, but it seems like that is the requirement at this point.

I have a dream that one day getting paid for providing awesome healthcare services won’t be such a contentious, convoluted mess.

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