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Concerns with Anthem’s New Prior Authorization Policy for Imaging Services

Monday, October 30, 2017 8:25 AM | Carol Burke (Administrator)

This past week, MSSNY staff joined representatives of the New York State Radiological Society to meet with the New York Department of Financial Services to express strong concerns with Anthem’s new policy imposing new prior authorization requirements as a precondition of patients receiving hospital-based imaging services.  In particular,

MSSNY expressed concerns regarding the additional administrative hassles imposed on referring physicians seeking to assure their patients can receive needed MRIs or CTs in a timely manner.  Moreover, concerns were expressed regarding the likely continuity of care issues for some patients, as well as the fact that such additional criteria for accessing these services of particular radiologists may not be clearly identified when a patient is looking at which physicians participate in a particular health insurer’s network.

To aid in its investigation, DFS representatives asked MSSNY and NYSRS for examples of instances where patients have been unable to receive the care they need, or have had their care unduly delayed, as a result of this new prior authorization requirement. Please contact rmcnally@mssny.org if you would like to share your story.

Similar prior authorization requirements have been imposed in other states by Anthem.  As a result, the American Medical Association EVP Dr. James Madara wrote a letter to Anthem EVP Dr. Craig Samitt urging Anthem to reconsider this policy given the “potential adverse impact on patients’ timely access to medically necessary care”, and concerns that the “new policy interferes with the patient-physician relationship and may disrupt ongoing care coordination”.

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