Cigna will not cover MRIs and CT scans performed in a hospital setting if they don't meet new medical necessity requirements, according to a policy that took effect Aug. 1.
Other commercial insurers, including Anthem, have similar policies in place. The policies aim to direct patients to less pricey freestanding facilities for imaging services.
Under Cigna's policy, MRIs and CT scans administered in a hospital will only be covered as medically necessary for patients who are less than 10 years old, need obstetrical observation, require perinatology services, have imaging related to a transplant procedure or have an allergy to the contrast used in the imaging, or if there is no other appropriate site due to surgery, anesthesia and other stipulations. All of the indications are listed here. All other hospital-based MRIs and CT scans won't be considered medically necessary.
"The goal of the policy is to provide coverage for our customers, and ensure they can get the right care at the right place and the right time," a Cigna spokesperson told Becker's. "That means helping to direct them to a freestanding radiology center or other office-based setting when there is not a clinical reason for services to be performed at a more costly hospital setting while continuing to allow coverage for services to be performed at a hospital location when the customer's condition truly warrants that level of care."
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