health planS ADD NEW 2018 DENIALS

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In an effort to drastically change consumer behavior, certain health plans are making sweeping policy changes that will impact if and how they reimburse for typical procedures.  Wouldn't you think that the following should be included in all health plan coverage:

1. Providing for Outpatient surgery options that are typically more cost effective and don't require a stay in the hospital
   1. In 2016, certain "skinny" health plan options started appearing that denied this service.  Read more here
2. Imaging (e.g., X-rays, CT scans) during hospital stays
   1. If you live in Virginia, California, Connecticut, and Maine, then Anthem is denying all imaging done within a hospital in an effort to steer more of this type of work to more cost-effective settings, such as physician offices.  Read more here
3. ED care when an emergency is needed
   1. Anthem is denying certain types of care delivered through the ED (see more on this here).  In fact, it is estimated that Anthem will deny 1 out of every 6 ED visits this year if they enforce this policy.