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Smart Choice MRI, a two-location discount MRI provider in Milwaukee and Sheboygan, Wisconsin, says a major area hospital chain is blocking patients from going to Smart Choice for scans. The hospital chain says the problem lies with Smart Choice, which it refers to as a “competitor.”

For any MRI scan, Smart Choice charges a flat $600, which includes a remote read of the images by radiologists at Cleveland Clinic. Here’s the back-and-forth of its dispute with Wheaton Franciscan Healthcare, as reported Saturday by Guy Boulton of the Milwaukee Journal Sentinel:

Eric Haberichter, Smart Choice co-founder and co-owner: Wheaton Franciscan’s physicians refuse to get insurance company–required MRI pre-authorizations for scans at Smart Choice.

Anne Ballentine, a Wheaton Franciscan spokesperson: Wheaton Franciscan’s policy is that whatever hospital or clinic is providing the service must get the pre-authorization, although Wheaton Franciscan will give other providers the documentation needed for the pre-authorization. She explained:

We believe it is up to our competitors to do the needed pre-authorization for the services they are going to provide and get paid for.

Haberichter: Smart Choice MRI’s contracts with health insurers require that the referring physician handle the pre-authorization.

Coreen Dicus-Johnson, a Wheaton Franciscan senior vice president who oversees contracting: Smart Choice could obtain the pre-authorizations itself. “I am telling you that unequivocally, because we do it all day long,” Dicus-Johnson said. She said Wheaton Franciscan handles the pre-authorization when an independent physician refers a patient there for an imaging test.

Haberichter: That’s different. Wheaton Franciscan is allowed to handle pre-authorizations for independent doctors who have privileges at Wheaton Franciscan hospitals. Besides, physicians at other health systems handle pre-authorizations for their patients who go to Smart Choice for MRIs.

Spokespeople for two other Milwaukee-area health systems, Froedtert Health and Columbia St. Mary’s: Yes, our physicians do take care of the pre-authorizations. Lisa Froemming, a spokesperson for Columbia St. Mary’s, said insurance companies require that the physician ordering a diagnostic test obtain the pre-authorization.

Anthem BlueCross BlueShield in Wisconsin: Its preference is for the referring physician to handle the pre-authorization, but it allows some flexibility.

UnitedHealthcare in Wisconsin: It has been requiring “prior notification” rather than “prior authorization” from the referring physician for imaging tests, but starting today—July 1—it will require prior authorization.

Let’s hope, for everyone’s sake, that this gets sorted out before lawyers and courts get involved.

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