Anthem steers members away from hospital-based imaging services, toward cheaper sites of care

Anthem says its new Imaging Clinical Site of Care program gives members an opportunity to save up to hundreds of dollars on tests like MRIs or CT scans. (Matthew Hurst/CC BY-SA 2.0)

In a move that it says will save members money, Anthem is rolling out a program that steers individuals away from hospital-based imaging services and toward less costly, freestanding imaging centers.

The insurer began its new Imaging Clinical Site of Care program on July 1 in Indiana, Kentucky, Missouri and Wisconsin, Anthem said in a statement sent to FierceHealthcare. Starting Sept. 1, Anthem will roll it out to four additional states: Ohio, Colorado, Nevada, Georgia and New York. The program is administered by AIM Specialty Health, a subsidiary of Anthem.

As part of the program, Anthem’s subsidiary reviews whether it is medically necessary for a patient to receive an advanced imaging service, such as a CT scan or MRI, in a hospital setting. If it is deemed necessary—such as when sedation is required for the procedure or when the services being provided are only available in a hospital—Anthem will cover the service. But if it’s not, Anthem will deny the request for authorization, meaning it won’t pay for the service at that site of care.

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For cases in which an imaging service doesn’t need to be done in a hospital setting, members who choose a free-standing clinic instead—and who haven’t yet met their deductible—can save close to $1,000 out-of-pocket for the service, according to Anthem. For those whose plans only require a copay, they could save up to $200.

In addition, the program also helps health plans keep premiums more affordable, the insurer noted.

“Anthem’s primary concern is to provide access to quality and safe healthcare for our affiliated health plan members,” the company said. “We are also committed to reducing overall medical cost where possible when the safety of the member is not put at risk.”

At least one hospital organization, however, isn’t thrilled about the new policy. Brian Tabor, president of the Indiana Hospital Association, told the Indianapolis Business Journal that physicians may have a good reason to order an imaging service in-house, and shouldn’t have to take time away from patient care to fight for reimbursement.

And Elizabeth Walker, chief strategy officer with the consulting firm Quorum Health Resources, told the publication that she predicts the trend will “disproportionately impact the razor-thin margins at community and rural hospitals.”

The Imaging Clinical Site of Care program on not the only recent cost-cutting move by Anthem to draw providers’ ire. The insurer has rolled out restrictions in some states for when it will cover emergency room visits, saying it will deny claims for minor injuries and conditions. But some provider groups worry that the policy might have a “dangerous chilling effect” on patients, causing them to forgo seeking life-saving care because of worries about facing higher bills.