DOTmed Home MRI Oncology Ultrasound Molecular Imaging X-Ray Cardiology Health IT Business Affairs
News Home Parts & Service Operating Room CT Women's Health Proton Therapy Endoscopy HTMs Mobile Imaging
Current Location:
> This Story

Log in or Register to rate this News Story
Forward Printable StoryPrint Comment



CT Homepage

MR and CT singled out as drivers of U.S. health care spending JAMA study finds scans are more expensive, abundant in U.S. than other high-income countries

CereMetrix Silver neuroimaging analytics platform scores FDA approval Quantifies brain function down to the voxel level

New study highlights gender disparity in radiology Fewer female radiologists are publishing research

The Image Gently Alliance 10 years later: challenges met and the future direction An update on the organization that pioneered safer imaging for kids

Q&A with Dr. Donald P. Frush; A more personalized approach to pediatric CT exams How a quantitative method could improve dose optimization when scanning children

Availity announces debut of pre-clearance service at HIMSS Confirms imaging authorization in minutes and ensures patient payments prior to visit

NCCN adds Axumin to guidelines for prostate cancer treatment Enhances support for imaging agent from private payors

Study suggests most emergency CT exams for head trauma may be unnecessary Not in line with current medical criteria

Aidoc launches first AI-powered full-body solution for CT analysis Supports radiologists covering head, c-spine, chest and abdomen

Radiology practices are willing to pay more for a better RIS Survey finds customizable systems with better workflow justify expense to providers

Anthem, Inc. now requires doctors to
formally request permission
for MR and CT scans

Doctors to apply for CT and MR scan permission under Anthem

by John R. Fischer , Staff Reporter
Physicians in specific U.S. states must now request permission to perform MR and CT scans on patients insured by Anthem Inc. as part of a new program set up by the Indiana-based company.

The Imaging Clinical Site of Care program directs patients to free-standing imaging centers when it deems hospital outpatient imaging services medically unnecessary, with Anthem asserting that the program helps members save money and keeps premiums for health plans at an affordable rate.

Story Continues Below Advertisement

RaySafe helps you avoid unnecessary radiation

RaySafe solutions are designed to minimize the need for user interaction, bringing unprecedented simplicity & usability to the X-ray room. We're committed to establishing a radiation safety culture wherever technicians & medical staff encounter radiation.

“When it’s not medically necessary for members to receive the services from hospitals, they can receive their imaging tests from a free-standing clinic,” Lori McLaughlin, a spokesperson for Anthem, Inc., told HCB News. “In those cases, these members can save close to $1,000 out-of-pocket for some imaging services, for those who haven’t met their deductible, and up to $200 for those whose plans require only a copay.”

The program first went into effect at the beginning of July for patients with local plans in Indiana, Kentucky, Missouri and Wisconsin. It will start on September 1 in Ohio, Colorado, Nevada, Georgia and New York and expand to Connecticut, Maine, and Virginia on March 1, 2018.

The premise of the program adheres to the principals of the Institute for Healthcare Improvement (IHI) Triple Aim Initiative, which advocates for the improvement of care in the patient experience, the improvement of population health, and reducing costs per capita in health care.

Under the new setup, doctors must submit precertification requests for MR and CT scans with Anthem, assessing whether the procedure is medically necessary for the patient and if the facility provides a level of care that meets certain criteria based on information collected by AIM Specialty Health, a specialty benefits management company. The criteria applied to providers and imaging centers include facility specifications, technologist and physician qualifications, accreditation and equipment.

If a procedure is approved but the hospital is deemed not worthy, the service will be denied and the physician will be sent a list of acceptable free-standing imaging centers where the procedure can be performed.

Physicians may appeal if they disagree with a denial, or go ahead with the procedure as planned, though the provider would incur the costs, according to Anthem's regulations.

Previous approved facility authorizations on file will be upheld until their expiration dates. Pediatric members also fall under this new guideline.

In a statement, the American College of Radiation criticized the decision, saying that it "compromises the physician-patient relationship" and creates unnecessary problems in the process of treatment.

"Denying patients covered access to care at such a vast number of facilities will delay care, increase wait times and force many patients to travel outside of their communities to get advanced imaging," it said in an official statement.

The program does not apply to clients under BlueCard, Medicare Advantage, Medicaid, Medicare Supplement or Federal Employee Program (FEP) plans, beneficiaries of an administrative services only (ASO) benefit plan, or those covered by DaimlerChrylser, Delphi, Ford Motor Group or General Motors.

CT Homepage

You Must Be Logged In To Post A Comment

Increase Your
Brand Awareness
Auctions + Private Sales
Get The
Best Price
Buy Equipment/Parts
Find The
Lowest Price
Daily News
Read The
Latest News
Browse All
DOTmed Users
Ethics on DOTmed
View Our
Ethics Program
Gold Parts Vendor Program
Receive PH
Gold Service Dealer Program
Receive RFP/PS
Healthcare Providers
See all
HCP Tools
A Job
Parts Hunter +EasyPay
Get Parts
Recently Certified
View Recently
Certified Users
Recently Rated
View Recently
Certified Users
Rental Central
Rent Equipment
For Less
Sell Equipment/Parts
Get The
Most Money
Service Technicians Forum
Find Help
And Advice
Simple RFP
Get Equipment
Virtual Trade Show
Find Service
For Equipment
Access and use of this site is subject to the terms and conditions of our LEGAL NOTICE & PRIVACY NOTICE
Property of and Proprietary to, Inc. Copyright ©2001-2018, Inc.