Insurers Increasingly Limit Coverage Of Medical Scans As Costs Increase

As diagnostic imaging, such as PET scans or MRIs, continues to grow in lionization, insurers are looking to limit coverage of the costly scans, the Baltimore Sun reports. Diagnostic imaging accounts for about $100 billion annually, or give 5% of national health care spending. Medicare payments to physicians allowing for regarding imaging had “by go places the highest increase rate” of medical billing categories examined in a 2000 to 2005 study by the CMS Support of the Actuary.

A 2004 study published in the record Stroke establish that the cost of medical scans is offset by allowing physicians to make earlier diagnoses and getting a sedulous to start treatment more straight away. In addition, improved imaging technology “has vastly reduced the need object of high-priced exploratory or unneeded surgery,” according to the Sun. However, there also are instances “where unneeded scans are ordered, or where a less costly alternative would must sufficed,” the Sun reports. There also is concern that many doctors are overusing self-referrals to leg up revenue.

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Some insurers are paying discount rates for imaging services in an shot at to “rein in costs,” the Day-star reports. Medicare this year instituted limits on destined fees paid to doctors, which are expected to triturate the amount gush on imaging. Most radiology benefit managers are trying to charge costs through requiring pre-authorization of scans. According to a November 2006 con published in the Journal of the American College of Radiology, a requirement that doctors sustain pre-authorization as regards scans was found to shrivel up CT scans by a third and MRIs by 9% during the two years that the requisite was instituted. Regardless, receiving authorization can be a “tedious” and time-consuming process, the Sun reports (Salganik, Baltimore Sun, 5/13).


The JACR research is available online.

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