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A success story in advocating for better radiology insurance coverage

by John W. Mitchell, Senior Correspondent | December 06, 2021
Pediatrics X-Ray
From the March 2022 issue of HealthCare Business News magazine

– Found friends: They got other medical groups on board with their push-back. In addition to the Society for Pediatric Radiology, the consortium also included The American Academy of Pediatrics, The American Hospital Association, The American Medical Association, the American College of Emergency Physicians, and the American College of Radiology.

– Built a campaign: These groups began a four-year campaign of letter writing, media appearances, and generally trying to raise awareness about how misguided the policy was. Two other insurance companies — United Healthcare and Cigna — also adopted the Anthem policy during their advocacy campaign. But eventually, Cigna (2020) and United Healthcare (2021) rescinded their decision and returned the adult age to 18.

Anthem resisted until August of this year, when it posted a new policy on its website, excluding pediatrics through 18 years of age. Heller said in making the announcement, Anthem listed back the talking points the consortium has been making. Among Anthem’s new reasoning:

– Children can require specialized pediatric equipment.
– Children are more radiosensitive than adults.
– Average doses are lower in pediatric facilities compared to general care facilities.

Aetna, another large insurance company, had been silent on the issue. But this year, they also announced a policy of steerage to outpatient providers, but excluded children and teens under the age of 18.

“(Aetna) was a battle that we won that we never had to fight. If you’re passionate about an issue, speak up. Be the squeaky wheel. This issue was taken care of because physicians stood up,” Heller concluded.

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