The call follows a lawsuit filed by Sovereign Health against insurance company Anthem for issuing payments directly to patients instead of to the out-of-network facilities that provided treatment services. Sovereign Health alleges that Anthem enacted this policy as a retaliatory act toward hospitals that do not elect to accept the company's low in-network rates, according to the ACR.
In a separate case, healthcare insurer UnitedHealthcare has implemented, as of March 1, a policy that denies authorization for MRI and CT services in hospital outpatient settings for patients who do not qualify for exceptions. The policy requires an additional preauthorization process for patients who qualify but meet certain specifications, such as those who have contrast allergies or a chronic disease that requires frequent imaging.
All related member comments will be directed to Kathryn Keysor, ACR senior director of economics and health policy.
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