Anthem, Colorado hospitals butt heads over imaging policy

Health insurance giant Anthem implemented its controversial imaging policy in Colorado last fall which has limited CT and MRI coverage for the nearly one in five patients with private insurance in the state, according to a Denver Post report. Some experts question the motivation of the move.  

Anthem spokesman Tony Felts said out-of-pocket costs can be up to $1,000 less in free-standing imaging facilities compared to hospitals. And the trend of insurers trying to limit costs by mandating where patients receive care will likely continue.

“The program has been in effect essentially along the Front Range where there are free-standing imaging centers to choose from,” Felts wrote in an email to the Post. “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.”

However, some hospital leaders, including Brian Lentz, MD, and director of radiology at Children’s Hospital Colorado, point to the special needs of pediatric patients, which hospitals have in imaging equipment designed specifically for the age group as a factor Anthem overlooks.

And although Anthem’s policy exempts children under 10, older children still often need the equipment only hospitals can provide, said Lentz to the Post.

Read the entire story below.