Health insurers target advanced imaging services

Private payors call into question imaging reimbursements. Source: UC Davis Health System

Health insurers are targeting advanced imaging services for more aggressive oversight rather than imposing stricter controls across all services, due to increased costs and safety concerns, according to a study released by the Center for Studying Health System Change (HSC).

Some insurers are requiring prior authorization for advanced imaging studies. Lacking such approval, health plans can typically deny payment to the provider performing the imaging study, even though a different provider may have ordered the study, HSC said.

Repeated imaging may result from poor quality images generated by substandard equipment or from inaccurate interpretation of results by inadequately trained physicians. Regardless, some insurers are concerned that repeated use of CT scans, for example, can expose patients to excessive amounts of radiation, because these scans generally emit significantly larger amounts of radiation than traditional x-rays, according to the report.

Plan strategies range from informing physicians about evidence-based imaging guidelines to requiring prior authorization of services to credentialing physicians and imaging equipment.

Mindful of the physician backlash against managed care in the 1990s, health insurers are instituting requirements that they perceive to be less intrusive and burdensome for physicians. Some physicians, however, view the requirements as administratively onerous and obstacles to patient care, according to the study.

"Despite physician objections, health plans generally have stood firm because they believe the cost savings and patient safety gains outweigh the negatives," said HSC Health Researcher Ann Tynan, MPH, coauthor of the study.