Anthem Contracting

Anthem Contracting

Jim DeWees

11/1/2012

Hello Everyone, I received a letter from Anthem Blue Cross regarding a new contracting issue, and an ammendment to the existing contract. Has anyone else received this? Does anyone understand what is being changed? I have kept up on the politics of Obamacare and thought that I was in a good shape to understand now these practical implementation of this new law. They refer to this as PPACA (Patient Protection and Affordable Care Act), and are trying to explain it in a short one-page printout. From what I can tell from this letter, and what I understand from this letter, is Anthem is expecting to grow significantly. They state that in Indiana there are currently 843,000 un-insured individuals. Of this group, 320,000 will be eligible to have insurance through this Individual Exchange and another 59,000 will be eligible for affordable plans on the market (yeah, how many of us have seen any affordable plans ?? I wish I could find one that I could afford better than what I am currently paying....). It seems that Anthem is the company that is planning on providing these services/benefits for about 400,000 new subscribers just in Indiana alone. They also state that there are 2 separate plans that Anthem has created: Anthem's Individual Exchange Network Anthem's Individual Off Exchange Network They do not explain what the difference is, or what any of this means. It states that reimbursement for both networks will be the same fee schedule (which for Indiana is well below the Medicare rates, and often times their fee schedule doesn't even allow enough to pay for some of the components, especially for some of the feet that are on the market). Here, locally, many of the doctor's offices and clinics have information on their counters for patients to take and read. They are cancelling their contracts with Anthem due to a fee schedule issue. My doctor is no longer seeing Anthem patients after Jan 1, 2013 if Anthem doesn't come to an agreement with the fee schedule. The local hospital has also announced that they are not going to be in the Anthem network either. There is a large university in my city, which is the biggest employer by far, and all their employees and students have Anthem policies. Fortunately my family does NOT have Anthem insurance. We DID have it a few years ago, but that was when the local physicians and hospital were in a big battle over the fee schedules in 2006, and I switched my policy to another smaller insurance company. For my family (which consists of me and an 11 year old son), with $1000 deductible, it costs me over $900 per month. Fortunately, at the moment at least, I am able to afford this. But I know MANY families that do NOT have insurance because they just can NOT afford the $1000-$2000 per month for insurance. So far, I have not seen ANY new policies or options out there to get anything cheaper. And, yes, I am watching all the time, and looking to see if there is something that costs less than what I am paying for an individual family policy. This is a big mess. Does anyone out there currently understand anything about these 2 new networks that Anthem has created? Why are so many providers not signing the contracts? From what I see, the fee schedule is going to be the same (which is terrible to begin with), but it doesn't say anything about going down lower for this field as far as I can tell. This is just the beginning of the problems IF Obamacare goes into full force on Jan 1, 2014. It is going to be a real big mess, from what I can tell. Any feedback or education on this would be helpful. Thanks Jim DeWees, CP