Anthem won’t pay for many patients to get CTs or MRIs at Colorado hospitals anymore
The Denver Post
If you need to get a CT or an MRI scan, Anthem — the health insurer that covers nearly one out of every five Coloradans with private insurance — most likely won’t pay for you to get it in a hospital anymore.
That’s the result of a new policy Anthem implemented in the state last fall that it says cracks down on the higher prices hospitals charge for procedures that are known in the industry under the broad category of “imaging.” Under the policy, Anthem directs most patients to free-standing imaging facilities, where it says the out-of-pocket cost to patients can be $1,000 less than at a hospital.
There are exemptions in the policy for scans that are needed in an emergency or are conducted prior to surgery. Children under 10 are also exempted, as are people who live in rural areas far from any free-standing imaging facilities. The policy focuses on more complicated scans such as CTs and MRIs and excludes simpler scans such as X-rays.
“The program has been in effect essentially along the Front Range where there are free-standing imaging centers to choose from,” Anthem spokesman Tony Felts wrote in an email. “The lower the cost of the service, the more affordable the cost is to consumers, which enables the health plan to keep premiums more affordable.”
The change reveals a deeper trend in the health care system. As health costs rise, insurers are getting pickier about where or even whether they pay for certain services performed at certain locations.
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Pitkin County administrators are proposing a more than $142 million budget for 2020, which is about $6 million less than this year because of fewer construction projects and capital improvements.