Hospitals Cry Foul Over Anthem ' s Radiology Reimbursement Policy

In a previous post, I noted that health insurance company Anthem was refusing to pay the hospital rate for outpatient MRIs and CT scans, dictating that their insurance holders receive outpatient imaging services from less expensive free-standing radiology centers (see: Anthem Won't Pay for Outpatient MRIs and CT Scans in Hospitals). Hospitals are fighting back and taking Anthem to court over this policy (see:Hospitals cry foul and sue Anthem over new policies). Below is an excerpt from this article:County courtrooms are no strangers to contract disputes between local hospitals and insurers. Lately, though, they've had some big cases dropped in their laps as hospitals owned byHCA Healthcare,Sentara Healthcare andPiedmont Healthcare take health insurance giantAnthem to court over its new policies that restrict outpatient imaging and emergency department reimbursement.....The hospitals argue their contracts with Anthem, through its Blue Cross and Blue Shield affiliates, require all parties to agree to such material changes to the policies.They also say the imaging policy isn't really about medical necessity, as Anthem has said, because the insurer allegedly granted exemptions for hospitals that agreed to accept lower rates. The Anthem spokeswoman said the company does not comment on pending litigation.....Some legal experts say the hospitals are standing on solid ground, while others argue Anthem's policies are an important opening salvo to changing h...
Source: Lab Soft News - Category: Laboratory Medicine Authors: Tags: Healthcare Business Healthcare Delivery Healthcare Insurance Hospital Financial Radiology Source Type: blogs