Categorized | Colorado News, National News, News

Anthem Changes Clinical Guidelines in Cost Saving Moves

Adding to its recent decision to not cover imaging tests in hospitals, Anthem has established additional clinical guidelines designed to reduce overall medical costs for covered services.

Changes to the recently released guidelines include:     1.  In routine cases, deem not medically necessary the use of anesthesiologists and nurse anesthetists in monitoring anesthesia during cataract surgery.  2.  Deny payment for emergency department visits that are later determined to be non-emergency situations.   3.  Cut provider payments by 25 percent for separate evaluation and management services that are billed on the same day as the actual procedure.

It is speculated that the intent of the new guidelines is to redirect patients to less expensive non-hospital settings for care.

Read more at Kaiser Health News.

Read the Guideline at Anthem.




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