Radiologists are expressing “significant concerns” around a recently implemented payment policy from commercial insurer Cigna and the effect it will have on pediatric patients.
It was back in August that the nation’s fourth largest payer stopped covering most hospital-based CT and MR imaging, steering beneficiaries to cheaper freestanding facilities. Cigna exempted children under 10 years old from the policy, but the Society for Pediatric Radiology and others believe this cutoff is arbitrary, with many childhood diseases continuing into adolescence.
SPR and the American College of Radiology are urging the Bloomfield, Connecticut-based insurer to increase the age limit to 19 years for nonemergent, high-tech hospital imaging. Absent such action, they’re concerned pediatric patients will receive care from inexperienced physicians, leading to imaging overuse, excess radiation exposure and climbing costs.
“We believe this new policy will have a profoundly negative impact on the quality and safety of pediatric care for children and adolescents undergoing advanced outpatient imaging studies,” Society for Pediatric Radiology and ACR chairs Christopher Cassady and Howard Fleishon, both MDs, wrote to Cigna Nov. 24. “Economic steerage of pediatric patients, disregarding their optimal care, is neither appropriate nor in the patient’s best interest.”
Cigna isn’t alone in its coverage change, with other payers such as Anthem also steering patients toward cheaper outpatient imaging. However, the two radiology groups noted that another national insurer with a similar policy still allowed teenagers to use hospitals for nonemergent imaging. They’re asking for a discussion between the two sides “regarding the best path forward to ensure excellent care for pediatric patients balanced with the need to be sensitive to cost factors.”
ACR said it received a preliminary response on Monday, noting that Cigna is reviewing the request. You can read the entire letter here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.