Eleven national medical and patient advisory groups have had it with Anthem Inc.’s outpatient imaging policies for MR and CT, deeming them “harmful” to and likely to “jeopardize” patient care.

The group expressed these and other sentiments to the payor this month in a letter, warning that failure to rescind these policies limits options for places of care available to patients, disrupts provider partnerships and reduces necessary reimbursements.

“For many residents – particularly those in inner cities and rural communities – the hospital outpatient department may be where they get a great deal of their health care,” Cynthia R. Moran, American College of Radiology executive vice president of government relations and health policy, told HCB News. “They may already know the providers and be comfortable making decisions with those providers. Those patients who prefer to get their care in this setting should be allowed to continue to do so.”
Anthem has been hit with criticism since 2017 when it chose to implement policies that include denial and redirecting of advanced imaging procedures from outpatient environments that it deems unnecessary and required prepayment reviews of CT and MR exams performed by emergency departments.

The letter argues that such regulations disrupt relationships between physicians and radiology practices, prevent patients from accessing lifesaving services, and places pressure on ED physicians not to perform CT or MR procedures that are critical for the diagnosis of patients in emergency situations.

It also accuses Anthem of violating federal patient protection laws by denying coverage for ED procedures and diagnoses not considered emergencies, and of ignoring commonly accepted valuation processes with plans to reduce reimbursements for evaluation and management procedures by 25 percent as of March 1, 2018.

Moran says Anthem should expect to receive further calls for the elimination of their policies as they are widely disapproved of in the health care industry.

“Legislation has been introduced in Virginia to stop these Anthem-type policies from being implemented there. The more people know about these Anthem outpatient imaging policies, the more they don't like them,” she said. “Also, those who signed the recent letter to Anthem are not the only groups disappointed with Anthem decision-making. They are implementing other controversial policies that are negatively impacting patients and providers. Expect others to publicly express their frustration moving forward.”

CT Homepage