Minnesota Insurers Limit Coverage Of High-Tech Imaging Procedures, Reduce Number Performed

Main Category: Health Insurance / Medical Insurance
Also Included In: Radiology / Nuclear Medicine;  MRI / PET / Ultrasound
Article Date: 03 Dec 2007 - 5:00 PDT

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New restrictions by Minnesota insurance companies on the use of high-tech imaging procedures have reduced the number of scans performed in the state, the St. Paul Pioneer Press reports. According to the Pioneer Press, health care officials "dispute whether the restrictions have healed or harmed the medical system," and physicians claim that "their time is wasted and their costs increased when they have to call health plans for permission to run a test." However, insurers "anticipate millions of dollars in savings, which should lower health care premiums for everyone," according to the Pioneer Press. Charles Fazio, chief medical officer for Medica, the second-largest insurer in the state, said, "We think this gets to most of the overuse in imaging." The rate of high-tech scans among Medica's members has dropped by 10% since the company in March began discouraging physicians from imaging procedures not recommended by the American College of Radiology, and the number of imaging requests that do not follow medical guidelines also has decreased.

However, although physicians "agree the restrictions ... have halted runaway growth in imaging procedures," they "bristle when insurance executives talk about the medical benefits," according to the Pioneer Press. Insurance executives and physicians are working together to develop a centralized system that would give physicians immediate and consistent advice on whether a scan would be covered, which would limit the "lost time and hassle" of the current system and save money for insurers because they would not need to hire contractors to evaluate physician requests (Olson, St. Paul Pioneer Press, 11/28).

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