UnitedHealthcare caves to pressure, exempting some imaging services from cost-cutting program
UnitedHealthcare has caved to pressure from physician groups, exempting certain imaging services from a cost-cutting initiative.
The country’s largest commercial insurer first launched its Designated Diagnostic Provider program in 2022, steering beneficiaries to imaging centers and hospitals that meet quality and efficiency requirements. United’s focus has been around major imaging services such as MR, CT and PET, hoping to deliver a better beneficiary experience while improving outcomes.
Both the American College of Radiology and American Academy of Pediatrics have advocated for more than a year, asking UnitedHealthcare to exempt all children’s imaging from the program. UHC has now relented after initially only exempting patients under age 7.
“ACR and AAP met with UHC several times to discuss the unique nature of pediatric imaging for patients under age 18 that makes it extremely difficult for pediatric-focused imaging facilities to become [Designated Diagnostic Providers],” the college said in a news update shared Thursday, noting the change took effect May 1. “ACR and AAP continue to work with UHC to communicate the updated policy to physicians and patients,” it added later.
UnitedHealthcare determines Designated Diagnostic Providers via an online questionnaire shared with in-network hospitals and imaging centers. Patients under certain plan types can use this perk to earn reduced cost-sharing benefits when choosing preferred providers. DDP is available across about two dozen states, where permitted by insurance regulations, including Florida, Georgia, Arizona, Nevada, Ohio, Wisconsin and Michigan. UnitedHealthcare also offers several other exemptions, among them, for emergency room imaging services, and for ultrasound, mammography and X-ray.
“Designated Diagnostic Provider benefits help protect members from higher, unjustified costs for outpatient lab or major imaging services while maintaining access to quality, safe, and efficient providers. These benefits are part of a strategy to lower overall healthcare costs,” UnitedHealthcare said on the program’s information page.
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.