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Be alert for Anthem pilot project on radiology services
e-Reports, Jan. 10, 2011
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In a Dec. 15 meeting with ISMA leaders, David Lee, M.D., vice president of health care management for Anthem Blue Cross and Blue Shield in Indiana, issued a reminder about a project announced in a Nov. 30 Rapid Update.

Launched in Central Indiana only Dec. 1, the pilot is intended to steer Anthem insureds to “high quality, affordable imaging services.”

Dr. Lee explained that when physician offices call for pre-certification for non-emergency imaging services like MRI or CT scans, Anthem representatives will inform the caller about alternative radiology service providers who may offer higher quality services – or equal quality but lower cost.

If the practice declines the suggested alternative, Anthem will contact the patient to provide the same information. If the patient declines to change, Anthem’s effort ends. Patients incur no penalties for not choosing lower-cost options, which may have saved them 10-15 percent on their out-of-pocket share.

“The ISMA wants to make certain our members are alerted to expect these calls and perhaps some

inquiries from patients in these counties who are contacted by Anthem,” said Mike Rinebold, ISMA director of Government Relations.

In the Rapid Update, Anthem noted its goal is “to provide members with information to help them make informed choices about their health care.” Find that notice here.

 

Anthem pilot program

Anthem selected nine Indiana counties for its radiology services pilot project, which will exclude pediatric and cancer cases as well as services for members in these counties already seeing a “preferred” imaging service provider

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