The American College of Radiology (ACR) has come out in support of the Health Insurance Coverage Decisions and Medically Necessary Services Act (HB 1445), which was introduced in the Virginia House of Delegates by Patrick A. Hope, D-47. According to the ACR, the act will protect patients from insurer profit-driven coverage gaps and preserve patient and referring provider choice regarding where to receive care.
Beginning March 1, Anthem will deny coverage for virtually all medically necessary imaging exams in Virginia if they are done in a hospital outpatient department. With only a few case-by-case exceptions, Anthem will require patients to travel up to 30 miles to get a scan in a facility where they may not know the providers. That facility may also not be able to readily share the results with their doctors if they do not use the same electronic medical records system.
“Barring patients from getting necessary imaging exams in an entire site of service like hospital outpatient departments is extreme and unprecedented,” says Virginia resident and American College of Radiology Chief Executive Officer William T. Thorwarth, MD, FACR. “It stands in the way of efforts to better coordinate care. It takes decisions out of the hands of patients and their providers. The Anthem policy interferes with shared decision making and integrated care.”
“The Anthem action is, at heart, a contract dispute between the nation’s largest Blue Cross Blue Shield plan and hospitals,” says Hope. “Insurers should not be allowed to make the people of Virginia pawns in their efforts to increase profits. These are people’s lives they are messing with. It can’t be allowed to happen here.”