Cigna officially stops covering hospital-based CT, MR imaging after months-long delay due to pandemic

The nation’s fourth largest commercial insurer has officially stopped covering most hospital-based CT and MR imaging after briefly shelving the proposal amid the COVID-19 pandemic.

It was back in February that Cigna first announced plans to label such high-tech scans as “not medically necessary,” except in a few limited scenarios. The policy was slated to go into effect on April 14, however, the Connecticut-based payer decided to delay the implementation date by four months, a spokeswoman told Radiology Business Wednesday.

Cigna officially went live with the new restriction Aug. 1. It carved out a few exceptions for hospital-based radiology care, such as if a patient is less than 10 years old, has a contrast agent allergy, or cannot find an alternative imaging site. Absent such circumstances, the insurer is steering beneficiaries to standalone centers where providers charge considerably less.

“Freestanding imaging facilities may offer Cigna members a lower cost alternative than a hospital-based imaging department or facility for medically necessary non-emergent imaging procedures,” the company said in its announcement.

Cigna isn’t alone in making this move. For instance, Anthem, the country’s second biggest payer, implemented a similar policy in 2017. At the time, company officials said some patients could save upward of $1,000 out of pocket for some imaging services by opting to visit a freestanding center. One analysis that year estimated that MRI and CT exams could cost upward of 149% more at a hospital compared to a freestanding center.

Certain plans administered by Cigna also have the ability to exclude their members from this change. Other exclusions include if outside imaging could adversely impact care, or a patient has been diagnosed with claustrophobia and requires open-air MRI that is not available at a freestanding site. The coverage change also applies to CT and MR angiography.