Diagnostic imaging is one of the fastest growing segments of medical cost, at nearly 15 percent of total health care spending. The rapid development and use of high-technology imaging procedures, in particular, is driving up costs.
High-tech imaging procedures typically include MRIs (magnetic resonance imaging), MRAs (magnetic resonance angiography), MRSs (magnetic resonance spectroscopy), CT (computed tomography) scans, CTA (computed tomography angiography) scans, PET (positron emission tomography) scans and nuclear cardiac imaging.
Weighing Value Vs. Cost
While high-tech imaging services such as these can help doctors diagnose serious diseases, experts agree that these tests many times add little or no information to improve a patient’s diagnosis or treatment. These services are also very costly compared to traditional diagnostic tests such as X-rays. Because of the increase in utilization and the high cost of these services, significant cost increases have been passed on to all health care consumers.
Trends in spending for high-tech imaging in Tennessee reflect what is taking place nationally. In some cases, radiology investment and spending in the state even exceeds national averages. For example:
Sources: MedSolutions Web site, medsolutionsinc.com; Increasing Efficiency and Information-Sharing. Medical Cost Reference Guide, BlueCross BlueShield Association; internal BCBST data; Bureau of Labor Statistics; 2001 Area Resource File, OECD Health Data 2001.
For members in fully insured health plans
Any time a doctor in Blue Network P or S recommends an outpatient MRI or other high-tech imaging test, the test or procedure must be authorized in advance. No authorization is needed for the tests in an emergency or as part of an inpatient hospital treatment plan.
The types of high-tech imaging services included are magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), magnetic resonance spectroscopy (MRS), computed tomography (CT scans), computed tomography angiography (CTA scans), positron emission tomography (PET scans), and nuclear cardiology.
If a Blue Network doctor suggests one of these outpatient procedures, it's important to know that:
Your Blue Network doctor or hospital should request prior authorization for these tests or admission. However, it is your responsibility to get prior authorization before receiving these services from a provider that is not in your network or outside the state of Tennessee. If you do not receive prior authorization for these services, you will often have to pay all or a larger share of the costs.
To begin your prior authorization review for a high-tech imaging procedure, call the number on the back of your BlueCross BlueShield of Tennessee member ID card.