It is now official- one of the largest commercial insurers in the US, Cigna will no longer cover most of the hospital-based MR and CT scans. While the proposal had been put forward by the company sometime earlier, it was briefly shelved owing to the ongoing coronavirus pandemic.
The news about Cigna’s plans, which presently stands as the fourth largest payer in the country, was reported in the October 2020 issue of Radiology Business. But to the people who stay updated with the latest news related to health and insurance, this move is hardly a surprise.
It’s because Cigna is not the only insurance company to have brought these changes. Anthem, which stands as the second biggest payer in the insurance sector, had already brought in similar changes in the policy back in 2017.
Back then, Anthem’s official stand was that patients could save upward of $1000 by opting for freestanding centers in place of hospitals for these scans. True to their claims, independent analysis from the year showed that MR and CT scan imaging in hospitals cost as much as 149% higher than the freestanding centers. No sooner has Anthem rolled out this change, another major insurance company too closely followed foot with new policies set in similar lines.
It may be said that Cigna is simply following the example that has been set by these major insurance companies.
The first announcements for Cigna’s plan came in February, just before the Coronavirus pandemic hit with the plan for implementation from April 14. But viewing the situation, the Connecticut-based company pushed the implementation date by four months. Finally, from the month of August, the new policies have become live. This means if you are insured with Cigna, you will no longer get coverage for hospital-based MR and CT imaging. However, it is important to understand here that the policy change does have certain exceptions. In fact, in the company’s own words, it plans to terms these scans as “not medically necessary,” except in specific scenarios.
However, if you are eager to read the list of exceptions, you may be disappointed to see a rather short roll. This includes cases where the patient is aged less than 10 years or if a person has contrast agent allergy. It is also applicable in case there are no alternative imaging sites available to the patient. The company has also included patients who suffer from claustrophobia for whom open-air MR is not available in their vicinity.
The reasons put forward by Cigna are similar to that of Anthem from two years ago. Freestanding test centers are a more cost-effective alternative compared to the hospitals when the insurance holders are required to go for advanced imaging.
But is the step really appreciable is a question that is playing in most minds right now. Taking note of the national scenario may be helpful in understanding that.
At present, more than fifty percent of the working adults in the United States are covered by health insurance. So an affordable alternative is indeed a welcome change in such a situation. It is also important to note here that cost efficiency is not being pushed at the cost of quality. The freestanding imaging providers are solely dedicated to this one task. So quite often, their quality actually surpasses that of hospitals.
If you look at the general trend, then too, you will realize that almost all the health care services that you get through a hospital are actually the most expensive. This applies to diagnostic imaging too. By opting for the freestanding providers, each patient can save up to several hundred dollars. The doctors will also get the required diagnostics within time, given that most of the freestanding centers offer prompter service compared to the conventional system run by the hospitals.
Now that the onus for selecting the imaging service is on you, it is essential to make informed choices. sepStream® prides itself on offering the most affordable and dependable imaging solutions in the industry. With the emphasis on acquiring the latest and the best technology along with sophisticated diagnostic tools, there can be no doubt to the resulting quality delivered by us.