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  • Washington Highlights

    AAMC Signs Community Letter Questioning Anthem Payment Policies

    Len Marquez, Senior Director, Government Relations

    The AAMC March 5 signed a hospital community letter to Anthem asking the insurer to abandon coverage policies for outpatient imaging and emergency care services that could diminish access to care. The letter, signed by six other hospital groups, cited Anthem’s retroactive decision to deny reimbursement for emergency services they deem “inappropriate.”

    This policy, the letter states, “…is both dangerous and out of compliance with the ‘prudent layperson’ standard…Anthem’s policy puts the patient in the position of knowing their diagnosis before seeking care and the clinician in the position of both knowing that diagnosis and turning the patient away from the emergency room.”

    Additionally, Anthem recently changed coverage rules for outpatient imaging. According to the new policy, Anthem will no longer pay for magnetic resonance imaging (MRI) or computed tomography (CT) scans delivered at hospitals in nine states in which it operates, unless found to be medically necessary for the scan to be performed at a hospital. This policy, the letter states, “lack[s] transparency for patients and providers, discourage[s] patients from seeking appropriate and timely treatment, inappropriately place[s] Anthem between patients and their clinicians, and make[s] material – out of cycle – changes to existing contracts between insurers and hospitals.”