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ANTHEM BLUE CROSS CHANGING REIMBURSEMENT METHODOLOGY AND INCREASING ENROLLEES' PREMIUMS
Anthem Blue Cross is planning on changing its reimbursement methodology to a $75 flat fee as of March 1. Other private insurers may do the same if Anthem succeeds. OTAC is collaborating with the California Physical Therapy Association and the California Speech-Language-Hearing Association in an effort to educate Anthem, the California Department of Managed Health Care (DMHC) and the California Department of Insurance about the detrimental impact this action will have on access to quality therapy services for Anthem enrollees.
We have met with Anthem as well as the DMHC and are planning another meeting with them. We have involved local and national experts who have provided some guidance. The legal and regulatory remedies appear to be limited. And as professional associations, we cannot negotiate contracts, we cannot organize groups of providers to boycott Anthem and we cannot demand higher payments.
The most recent communications reveal:
- Anthem Blue Cross will not negotiate rates or contract terms with providers
- Anthem Blue Cross feels they will have adequate coverage once the processing of new applications is complete
- Anthem Blue Cross has focused on converting existing contracted providers (direct or PTPN providers) in order to ensure continuity of care for their patients when the new rate structure takes effect and the relationship with PTPN ends
- Anthem Blue Cross has not yet processed or responded to the majority of new contract requests from providers who were not previously in-network
The California Department of Managed Health Care (DMHC) is very much aware of the issue and have had direct contact with Anthem. Although DMHC does not control rates, they have asked the three collaborating associations for more information to assist them with their evaluation of the situation which we have provided. In addition, the Anthem Blue Cross situation has received attention from both the U.S. Department of Health and Human Services and President Obama's administration.
ACTION - HOW YOU CAN HELP: We feel that while there continues to be a microscope on Anthem that now is the time to continue with our advocacy efforts. Sample letters are available on our Web site. We encourage you to submit letters voicing your concern about Anthem's change in reimbursement and its detrimental impact on rehabilitative services.
Letter to Members from OTAC/CPTA/CSHA.