Starting Friday, insurance giant Anthem will not be so willing to pay for some hospital-based MRIs and CT Scans in Colorado and four other states.
In a move widely seen as an effort to contain rising costs for imaging services, Anthem intends to require a “medical necessity review” of orders for CTs and MRIs at hospital outpatient facilities. Anthem clearly intends to direct patients toward freestanding imaging facilities.
Imaging orders inside hospital ERs (and other inpatient hospital facilities) will not be impacted.
FULL INVESTIGATION | 9NEWS' Show Us Your Bills: One Year Later
Back in July, Anthem started doing this in Indiana, Kentucky, Missouri and Wisconsin.
In May, 9Wants to Know documented the story of Tony Carroll who was charged more than $7,000 for an MRI at a Colorado hospital.
The same MRI would have run him less than $1,000 at a variety of non-hospital based imaging centers.
The Colorado Hospital Association issued the following statement to 9News in light of Anthem’s decision not to pay for most outpatient imaging:
“This policy has the potential to adversely impact rural hospitals and communities who often have fewer alternatives than larger urban hospitals and communities. While CHA supports initiatives that seek to make health care more affordable, the Association is also squarely focused on ensuring access to care, especially in rural Colorado. As always, CHA recommends that patients contact their insurance provider to understand their coverage and to ensure that they seek the right treatment (or test) at the right time and at the right place.”