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Insurer Cuts Upright MRI Centers From Network

May 16, 2011
Written by: , Filed in: Diagnostic Imaging, Practice Management
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New Jersey’s largest health insurer has eliminated all seven of the state’s upright MRI facilities from its provider network, according to executives at one of those facilities.

The insurer, Horizon Blue Cross Blue Shield of New Jersey, has about 46 percent of the state’s health-insurance market. According to The Press of Atlantic City newspaper, Horizon said it had made two changes in its imaging contracts:

  • It now focuses on facilities that offer a wide range of radiology services rather than clinics that specialize. “We believe our members are better served when we provide facilities that can serve all or most of their radiology needs,” the insurer said in a statement.
  • It now contracts with freestanding imaging centers rather than with the individual radiologists who practice at those centers. In an announcement on its Web site, Horizon said it believes the change will help it “more easily keep pace with changes occurring in the radiology industry,” “track practice affiliations and locations,” and “evaluate radiology quality standards and compliance.”

The owners of two New Jersey upright-MRI clinics, Tilton Dynamic Imaging of Northfield and Ocean Upright MRI of Toms River, got a court injunction last month that temporarily allows their centers to remain in the Horizon network. A court hearing is scheduled for later this month.

Lee Getson, a partner in and president of Tilton Dynamic Imaging, said:

We’ve lost 40 percent of our business already. They [Horizon] call patients now and tell them they want them to go to other imaging centers.

Upright imaging centers cater to patients who are too large to fit into a conventional MRI, are claustrophobic, or have conditions such as scoliosis that make it difficult or impossible for them to recline for scans. Tilton Dynamic partner and administrator Norman Brettler said Horizon eliminated all seven of New Jersey’s upright MRI facilities from its network.

Brettler said Horizon cut its imaging provider network by about 40 percent, dropping about 100 of the state’s 260 licensed MRI facilities.

Horizon declined to comment specifically on its policies regarding MRI centers or upright imaging, citing theĀ  litigation. It did say in a statement: “We recognize that while most radiology centers provide a variety of imaging services, some are limited, and a smaller subset offer upright scanning (either exclusively or with other limited services). If a member’s physician determines that this type of service is medically necessary, and the center is out of network, the member would still have access to benefits that will cover an upright MRI.”

Granting “access to benefits” is not necessarily the same thing as simply covering upright MRI. A Horizon spokesman said that its members in managed-care plans would receive in-network charges if upright scanning were determined by their physicians to be medically necessary. Some other plans have an out-of-network benefit that would cover medically necessary upright scanning.

However, Getson said most out-of-network benefits have such high deductibles that most upright MRI costs would have to come out of patients’ pockets.

Related seminar: Musculoskeletal MRI

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