Anthem scraps policy that cuts payments for same-day services, but provider groups want more

Anthem has come under fire from providers for several new payment policies. (Image: Matthew Hurst / CC BY-SA 2.0)

Physician groups earned a victory when Anthem revealed it would roll back a controversial policy that would reduce payments for certain same-day services, while the American Hospital Association has joined the chorus calling for further changes to the insurer's ER payment policies.

Anthem said in a letter dated Feb. 21 that would not implement the payment modifier 25 policy, which would have reduced payments for evaluation and management services that were provided on the same day as a wellness exam or procedure. The insurer had previously adjusted the payment change to a 25% cut from a 50% cut. 

RELATED: More providers enter joint ventures with insurers to create health plans 


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Anthem said in a statement emailed to FierceHealthcare that it remains committed to providing access to high-quality care while seeking ways to reduce costs. 

"Anthem believes that making a meaningful impact on rising healthcare costs requires collaboration between healthcare providers and health plans," the insurer said. "We have been and will continue to have a dialog with our providers and medical societies about any of our programs." 

RELATED: Hospital, physician advocacy groups press Anthem for further changes to controversial policies

Meanwhile, the AHA has joined provider groups calling for Anthem to eliminate policy changes that would impact emergency care and imaging services.

Anthem announced that it would scale back emergency care coverage in several states and that it would steer patients toward freestanding imaging centers instead of hospitals to lower costs.

Providers strongly opposed the policies, as did patients. A survey conducted by the American College of Emergency Physicians (ACEP) one of the loudest detractors to the ER policy, found that two-thirds of patients were against the changes. Anthem scaled back the policy in response to the fallout, putting a series of "always pay" exceptions in effect.

The AHA, ACEP and American College of Radiology wrote in a joint letter this week that Anthem's changes fall short. 

"The changes to the policy announced by Anthem last week do not address the underlying problem of putting patients in the potentially dangerous of having to decide whether their symptoms are a medical emergency before they seek emergency care, or risk paying the entire bill if it is not," the groups wrote. 

Anthem has also taken heat from providers for a policy that marks monitored anesthesia as "not medically necessary" for routine cataract surgery.

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