Blue Cross VT just made it easier to get cheaper MRI scans at Vermont Open MRI

Vermont's largest medical insurance company is making it easier for patients to get cheaper MRIs at the only independent provider of the scans in the state − Vermont Open MRI in South Burlington.

Blue Cross and Blue Shield of Vermont announced on Monday that as of Feb. 1, 2024, it will no longer require prior authorization for health care providers to refer their patients to Vermont Open MRI. The cost of MRIs at Vermont Open MRI is four times lower than other Vermont facilities that perform MRIs, which are all hospitals, according to Blue Cross VT.

The change in policy is also expected to speed up appointments for getting MRIs. Currently, it can take months to get an appointment for an MRI.

"We live and work here, and we know implicitly that our neighbors endure long wait times for health care services and all too often struggle to pay the bill," Dr. Tom Weigel chief medical officer at Blue Cross VT, said in a statement. "Removing prior authorization requirements for services at Open MRI, we are supporting Vermonters to access a lower cost service that can cut the line on long wait times."

Regulators provided impetus for Blue Cross VT to drop prior authorization at Vermont Open MRI

Weigel said in an interview with the Burlington Free Press on Wednesday the impetus for dropping the requirement for prior authorization at Vermont Open MRI came from a question posed by Owen Foster, chair of the Green Mountain Care Board, which regulates major areas of health care in Vermont. Foster asked during rate hearings in September what Blue Cross VT was doing to "redirect care to high-quality lower cost options," according to Weigel.

"That prompted an internal discussion," Weigel said. "There are a few providers of services in the state, including Open MRI, where we saw opportunity. We dug deeper and the fact they had a new 3T machine helped cinch the deal."

3T refers to 3-Tesla, the unit of measurement for the strength of the magnets in the MRI machine, which affects the quality of the imaging. (There is no connection to the EV company.) The Siemens 3T MRI Vermont Open MRI installed in November is state-of-the-art, according to Blue Cross VT, and "has garnered exceptionally positive feedback from referring physicians for its advanced imaging capabilities, which aids in providing accurate diagnoses and comprehensive patient care."

The University of Vermont Health Network dominates the health care market in Vermont, leaving few independent health care providers. Weigel said there are two other independent providers, however, which could provide further opportunities in the future to streamline access to cheaper health care by removing the requirement for prior authorization, although nothing is currently in the works: Green Mountain Surgery Center in Colchester, and Retina Center of Vermont in South Burlington.

"These are other examples of high-quality, lower cost, non-hospital providers," Weigel said.

Vermont Open MRI struggled for recognition in market dominated by UVM Medical Center

In 2017, the Burlington Free Press wrote about a woman named Annie Ode, who had moved to Burlington from Boston, and needed regular screening because of her family's history of cancer.

Ode had just been charged $5,000 for a brain MRI that would have been $600 at Vermont Open MRI, but she said she wasn't told about her options by her doctor at UVM Medical Center. She said she was unaware Vermont Open MRI existed. Weigel said there's no requirement for a clinician to provide a patient with all her options for scans or other procedures, and that there's "certainly a motivation" for clinicians to refer internally because of convenience.

Dr. Stephen Leffler, then UVMMC's chief medical officer and now the hospital's president and chief executive officer, told the Free Press in 2017 UVMMC had no policy against providers ordering tests outside of the hospital, as long as they were of the right quality.

Leffler added, however, that the safest and quickest way for providers to order images or lab work was through the hospital's electronic medical records, which route all orders within UVM Medical Center's system.

More:High costs, few options in VT health care

Dr. Kristen Destigter, chair of UVM's radiology department, questioned the quality of Vermont's Open MRI's scans in 2017, saying the magnets used in UVM Medical Center's scanners were up to five times more powerful than the magnets used in Vermont Open MRI's scanner and "may perceive subtle differences in tissues that may allow you to determine if it's cancer or not."

Today, the magnet-strength playing field has been leveled, according to Blue Cross VT.

Contact Dan D’Ambrosio at 660-1841 or ddambrosi@gannett.com. Follow him on Twitter @DanDambrosioVT. This coverage is only possible with support from our readers.