by John R. Fischer
, Senior Reporter | May 10, 2021
The American College of Radiology and the Society of Pediatric Radiology have called on Anthem to do away with its policy of not covering hospital-based imaging for children, ages 10 and up.
Anthem covers hospital-based imaging on pediatric patients until the age of 10. It was one of the first healthcare insurers to implement this rule, with the aim being to steer patients toward cheaper free-standing options.
Both ACR and SPR wrote in a recent letter to Dr. John Whitney, Anthem’s VP of medical policy, that the restriction prevents patients from being seen by pediatric imaging specialists who make “a substantial difference” in the safety and accuracy of decisions made around imaging, and help to “improve outcomes” for child patients.
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Dr. Richard Barth, prior SPR president and professor of radiology at Stanford University School of Medicine, told HCB News that pediatric imaging specialists are more experienced in interacting with children and do not practice as much in outpatient settings as they do in hospitals. “These include pediatric radiologists, certified child life specialists, and nurses and technologists with pediatric competencies. As an example, certified child life specialists play an important role in reducing child anxiety and discomfort helping to assure a child's cooperation for their imaging study.”
ACR and SPR are asking Anthem to reimburse for nonemergent, high-tech imaging in hospitals for children until they are 19. They attest that the restriction is “artificial” as many childhood diseases extend into adolescence, and point out that insurers like Cigna and UnitedHealth have altered their cite-of-care imaging policies to include children in this age group.
“Economic steerage of pediatric patients, disregarding their optimal care, is neither appropriate nor in the patient’s best interest,” they concluded in their letter.