![]() ![]() Hospitals operate in a unique and complicated economic environment but, as a basic principle, like every other business, they must generate revenue in order to provide community health care services. “We object to this economically motivated steerage policy largely because it goes against our priority- upholding the quality of patient care-and forces people to weigh costs over the best options for their health,” says Texas radiologist Ezequiel Silva III, MD, chair of American College of Radiology’s economics commission. Stories abound about inadequate staffing, inadequate equipment, potentially life-threatening scheduling delays and case-specific complexities that are dismissed as irrelevant by Anthem’s third-party reviewers. They ignore choices based on experience with the quality of care and skill of the radiologist who performs and interprets the imaging study, according to a statement from the American College of Radiology. Decisions based solely on cost undermine the relationships between referring physicians and radiologists. Separate and apart from the issue of whether care is available, others ask whether the “least cost” metric produces the best care. Meanwhile, as the insurer’s coverage policy pushes patients to clinics, the number of freestanding imaging centers has actually declined because of changes in the industry and shrinking Medicare and Medicaid reimbursements. Other studies suggest that these coverage denials disproportionately affect women and minorities. These vulnerable patient populations already face significant care access care challenges, and the Anthem policy may exacerbate these existing problems." ![]() In California, Anthem currently insures roughly 15,000 people.Ī letter to Anthem from the American Medical Association expressed the organization’s deep concern that Anthem’s policy would negatively affect patient care: "We fear that the impact will be greatest on patients living in rural or inner city areas, where hospital outpatient departments may be the only nearby site of service for advanced imaging. But it also shines a light on the damage that Anthem’s plan does to hospitals and the wider healthcare system.Īnthem expects to implement this rule (formally named the Imaging Clinical Site of Care program and administered by its AIM Specialty Health subsidiary) in most of the states where it does business. The lawsuit focuses on the harm the policy does to patients. As a subpart of the strategy, Anthem refuses claims for in-hospital CT scans and MRIs ordered in the course of emergency diagnosis and treatment. Washington, DCIn July 2018, the American College of Emergency Physicians filed an insurance lawsuit against Anthem Blue Cross Blue Shield over the insurer’s new policy of denying emergency room coverage after the fact. ![]()
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