Anthem’s New Outpatient Imaging Policy will Hit Radiologists as Well as Hospitals

The Blues giant Anthem will no longer pay for MRIs and CT scans performed on an outpatient basis in hospitals across the country. Anthem is taking aim at a service line that can be far more expensive in a hospital than in a free-standing imaging center. For its fully insured members, Anthem will no longer pay for MRIs or CT scans delivered at hospitals in nine states this year, unless a review finds it was medically necessary to perform the scans at a hospital, which will be unlikely. The policy will be rolled out to all but one of the 14 states where Anthem does business by March 2018, ultimately affecting 4.5 million members. In the other states, patients will have to go to a free-standing imaging center instead of a hospital for some services. Anthem said the policy doesn’t affect patients enrolled in government programs, such as Medicare and Medicaid, or those with self-funded employer coverage. Anthem said the policy will help keep premiums low and gives patients an opportunity to save hundreds of dollars, especially those members enrolled in high-deductible health plans. The policy went into effect in Indiana, Kentucky, Missouri and Wisconsin on July 1, and it will start in Colorado, Georgia, Nevada, New York and Ohio on Sept. 1.