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Imaging Coverage Denials on the Rise

Health insurance coverage denials for medical imaging procedures recommended by physicians judged to be unnecessary are increasing, according to an America’s Health Insurance Plans (AHIP) report. The AHIP says imaging procedures account for nearly $100 billion in U.S. health care spending, but about half of scans for some conditions fail to improve patient’s diagnoses or treatments (Medical News Today July 30 report).
One way insurers are cutting down on unnecessary imaging procedures is with the use of radiology benefit managers. Read Wall Street Journal’s July 28 “Health Blog” for a discussion on what other programs health insurers are using to limit spending on medical imaging procedures.
A GAO report recommends Medicare follow suit and adopt prior authorization in an attempt to curb the rapid increase in Medicare imaging costs, says the Medical News Today report.

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