Anthem has changed their policy regarding imaging performed in hospitals on an outpatient basis and will expand this into fourteen states.  Hospitals are not happy, nor amused and have filed suit.  Anthem stakes its claim on the idea of medical necessity, and hospitals are saying that doctors have the right to show necessity, not carriers.  And so the battle continues as carriers continue to try to dictate care but those who are responsible for care are not responsible for the payment.  No winners here…

And as if that were not enough, Anthem has also begun pushing back on patients who visit the emergency room for ailments the carrier deems minor – called the “avoidable ER program” (as in avoiding payment).  While Anthem has lightened up on their procedures somewhat, they are refusing to pay some ER visits as non emergency (after the fact) which is not making patients and doctors particularly happy.  Stay tuned.