Daily News | Independence and Penn Medicine have eliminated preapprovals for thousands of high-cost scans
The Philadelphia area’s largest insurer, Independence Blue Cross, has started offering select Penn Medicine doctors a pass on the onerous paperwork typically needed to get patients approved for ultrasounds, CT scans and PET scans.
The pilot program covers 1,280 physicians employed by Penn at the Hospital of the University of Pennsylvania, Pennsylvania Hospital, Presbyterian Medical Center, and Chester County Hospital.To be included, doctors had to have a 12-month history of ordering the scans and a coverage denial rate of less than 5% with Independence, a signal that they are usually following IBC’s criteria for deciding what scans it will pay for.
Under the program, Penn is on the hook financially if its doctors start ordering notably more scans that don’t meet IBC’s guidelines. IBC pays thousands of dollars each for some of the scans.The IBC-Penn pilot is part of a trend toward rethinking health insurance preauthorizations, aiming to streamline and bring more transparency to the process, said Kaye L. Pestaina, codirector of the Kaiser Family Foundation’s program on patient and consumer protections.
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