LATEST NEWS | OCT 12, 2020
Cigna Officially Stops Covering Hospital-Based MR & CT Imaging
As of August 1, 2020, Cigna officially stopped covering most hospital-based MR and CT imaging procedures. The insurer, which is the fourth-largest in the nation, advised its members that freestanding imaging centers offer members a lower cost for medically necessary, non-emergent imaging procedures.
As diagnostic imaging procedures become more advanced and more crucial in healthcare planning while conversely, costs for healthcare continue to rise, freestanding imaging centers emerge as the solid choice for patients looking for cost cutting, convenience and expertise.
Imaging services, specifically MRI and CT, provided in a hospital can cost up to 3 to 5 times as much as the same service provided in a freestanding center. Company officials at Cigna said that some patients could save as much as $1,000 in out-of-pocket expenses for imaging services by opting to visit a freestanding center. And according to one analysis, MRI and CT exams could cost an upward of 149% more at a hospital, compared to a freestanding center.
If you're wondering why it is that the cost discrepancy is so extreme, the answer has to do simply with size. In an article published in USA Today, freestanding centers have the luxury of keeping their costs down because they are providing more focused services, maintaining smaller staff and overhead, and are not required to remain open around the clock every day. Large hospitals have large overhead, and the patient ends up paying for that.
Anthem, which is the second-largest insurer in the country, was first to institute a similar policy change. In 2018, they started denying claims for imaging procedures performed in a hospital radiology department, citing the same cost-related benefits. Cigna's plan allows for a few very specific exceptions for having an MRI or CT exam in a hospital: If the patient is 10 years old or younger, if the patient has an allergy to contrast, or if there are no freestanding centers nearby.
Both Cigna and Anthem have assured their members that they will save significant out-of-pocket expenses by seeking their diagnostic imaging procedures in outpatient centers.
Dr. John Crues | RadNet
"As a practicing radiologist, I am pleased that this program is finally being implemented,” Dr. John Crues said about the Cigna update. Dr. Crues is a Medical Director and Vice President of RadNet, and he added: “This is part of a wider program to try to address the rising costs of medical care and improve patients' access to high-quality, convenient care. For far too long the insurance companies have been trying to save money by directing patients to lower quality providers and shifting costs to the patient. Radnet's out-patient imaging centers are far more available and patient friendly than large hospitals, and the charges are far less for the same imaging procedures using state -of-the-art equipment and specialty trained radiologists to interpret the studies."
As a national leader in providing high quality, cost-effective diagnostic imaging services for over 35 years, RadNet is dedicated to advancing early detection of disease and to empowering patients to take charge of their health.
