State’s largest insurer lifts prior authorization requirement for MRI, steers patients to single provider
The largest commercial insurer in one northeastern state is lifting the prior authorization requirement for MRIs and steering patients to a single provider.
Blue Cross and Blue Shield of Vermont announced the new partnership with Open MRI on Jan. 22. It noted that the South Burlington-based provider group delivers magnetic resonance imaging exams at costs four times lower than some of its competitors.
Open MRI—which has a second location in West Lebanon, New Hampshire—also is expanding its hours to accommodate Blue Cross VT. Both locations will be open 7 a.m. to 7 p.m. Monday through Saturday, with occasional availability on Sundays.
“We live and work here, and we know implicitly that our neighbors endure long wait times for healthcare services and all too often struggle to pay the bill,” Tom Weigel, MD, chief medical officer at Blue Cross VT, said in an announcement. “Removing prior authorization requirements for services at Open MRI, we are supporting Vermonters to access a lower cost service that can cut the line on long wait times.”
The PA change will take effect on Feb. 1. Blue Cross VT said the high-quality technology offered at Open MRI was a “driving factor” in reaching this “strategic decision.” The practice recently installed a new 3-Tesla MRI machine that has garnered “exceptionally positive feedback from referring physicians” for its capabilities.
Vermont Open MRI Managing Member Todd Kummer said access has nearly doubled at the location since they added a 1.2T open scanner in 2021.
“The decision to add the 3T wide-bore scanner was simply to keep up with demand and meet the needs of referring specialists,” he said in the announcement.
The Burlington Free Press first reported news of the new partnership. It noted that the impetus for dropping the prior authorization requirement came after encouragement from Owen Foster, chair of the Green Mountain Care Board, which regulates healthcare in Vermont. Open MRI has reportedly struggled to break into the market, which is dominated by the University of Vermont Health Network
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.