We’ve expanded our Site of Care review program to determine whether it’s medically necessary for members to have various surgical procedures, such as hernia repair, biopsy, and hysteroscopy, in addition to upper endoscopy and colonoscopy, in a hospital outpatient facility.
Ambulatory surgery centers provide same-day surgical care, including diagnostic and preventive procedures. They offer the following benefits:
- Quality: Patients treated in ambulatory surgery centers have fewer hospital admissions and ER visits shortly following a procedure than those treated in a hospital outpatient setting. (Source: Journal of Health Economics Study, 2018)
- Access: More convenience and reduced wait times for scheduling patients, and easier to navigate than hospital campuses
- Cost: Commercially insured patients could save as much as $5 billion annually in out-of-pocket costs by having procedures performed in an ambulatory surgery center. They could save $1,000 per surgery. (Source: Healthcare Bluebook and Ambulatory Surgery Center Assoc., 2016. Commercial Insurance Cost Savings in Ambulatory Surgery Centers)
These clinical reviews apply to ASO (self-funded) Small and Large Group plans. Some exceptions may apply.If your ASO clients would like to add these reviews, please contact your Anthem representative for more information.