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.