Anthem in Missouri: 'Enormous' price differences influenced policy change for hospital-based imaging coverage

Anthem Blue Cross Blue Shield of Missouri in St. Louis said it stopped covering outpatient MRIs and CT scans at hospitals without prior authorization due to "enormous" price variations, St. Louis Post-Dispatch reports.

On July 1, Indianapolis-based Anthem ended coverage of hospital-based MRIs and CT scans in Indiana, Kentucky, Missouri and Wisconsin, and expanded the policy to Ohio Sept. 1. Hospitals will need to submit a precertification request for any patient receiving an MRI or CT scan at the facility, and the imaging service will only be covered at the hospital if Anthem deems the request medically necessary. The change aims to incentivize the use of cheaper alternatives at freestanding facilities.

Jay Moore, MD, senior clinical director of Anthem Blue Cross Blue Shield of Missouri, told St. Louis Post-Dispatch the payer is seeing price "differences of like 500 percent" for the services. "It just doesn't make sense. It's ridiculous in terms of the amount of cost differential."

Missouri Hospital Association spokesperson Dave Dillon told the publication, "Everything is more expensive in the hospital because we're a 24-hour-a-day operation."

To learn more about the change in policy, read the FAQ from Anthem.  

More articles on payer issues:
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