Are new insurance policies putting patients at risk?

Blue Cross Blue Shield giant, Anthem, announced earlier in 2017 that it would no longer pay for MRIs and CT scans performed on an outpatient basis in hospitals. Instead, its members will be required to go to a free-standing imaging center for these services. This policy is expected to roll-out to all but one of the fourteen states where Anthem conducts business, and will potentially impact 4.5 million members. This imaging policy follows Anthem’s prior announcement that it will no longer pay for emergency room visits that may be later deemed “non- emergency.” Now I don’t know about you, but if I’m an Anthem member and I begin having chest pains, I don’t want my first thought to be that maybe I should hold off on visiting the ER in case what I’m experiencing isn’t, in fact, life-threatening.

Even most recently, Anthem rolled out another alarming policy change that categorizes monitored anesthesia care as “not medically necessary” during cataract surgery.

Anthem’s policy changes are setting a dangerous precedent for patient care and is facing pushback from providers and politicians alike.

The coordinated care model has shown to greatly improve outcomes for patients, but Anthem’s new policy change aimed at steering patients toward freestanding imaging centers, rather than hospitals, completely undermines this concept. The unnecessary complication only further adds to the dysfunction of administering medicine. Physicians will likely spend more time chasing paperwork and reimbursements than overseeing patient care, which adds to the costs that hospitals will then absorb in return. It’s also alarming that now an insurance company can determine the setting and manner of patient care and not the physicians who have spent decades perfecting the practice of medicine and have the patient’s health and safety as their first priority.

Consider cancer patients who often receive treatment within a hospital cancer center. Under Anthem’s new imaging policy, they would be required to leave the hospital, travel to an outpatient facility for imaging, then request to have the imaging read and transmitted back to the hospital. It’s also possible that these same patients may even be required to deliver the imaging on a CD to the physician themselves. This new policy adds another layer of discomfort to what is already a very traumatic experience for these patients.

Health benefits that patients insured by Anthem rely on and pay for are gradually being dismantled—and with each restriction Anthem imposes on its members, it’s spending less money. We must ask ourselves why then are Anthem members seeing double-digit premium increases year-after-year? Where are these savings going? The money is clearly not finding its way back into the pockets of Anthem members or employers, who often pay for their employees’ benefits.

the health systems Push back

One health system in particular has lead the fight against Anthem’s new, widely criticized imaging policy. In late 2017, Northeast Georgia Health System (NGHS) filed a lawsuit against Anthem Blue Cross Blue Shield of Georgia (BCBSGa), who shortly thereafter voluntarily withdrew the application of the policy to NGHS pending scheduling a hearing before the Court. NGHS is the first health system in the U.S. to file a lawsuit against the insurer regarding the policy. Since then, Piedmont Hospital in Atlanta, GA and its five sister facilities have also followed in the footsteps of NGHS, pushing back against Anthem’s imaging and ER policies with a lawsuit filed in mid-February.

Additionally, state regulators and other providers have begun standing up for patients and for the fundamental purpose of health insurance. Ohio lawmakers have introduced a new bill in the General Assembly seeking to block Anthem from denying to pay for certain patients’ ER claims. National advocacy organizations like the American Hospital Association, the American College of Radiology, the American College of Emergency Physicians and eleven others are calling on Anthem to rescind its harmful policies — they sent a letter directly to Anthem’s Chief Clinical Officer and cited their concerns for the safety of Anthem’s patients.

Under pressure, Anthem did announce it would roll back another contentious policy that would reduce payments for certain same-day services, but opponents say that’s not nearly enough. The underlying problems associated with patient safety are not addressed and the remaining policies still put patients at incredible risk. Although the future of these policies is still unclear, patients can expect that these policies won’t be implemented without a fight and others will come forward to intervene in the months ahead.

May 23, 2018
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