MEDELECT, Inc. is seeing this more and more across the board with all insurances and we want the public and providers to be aware of changes coming in 2017.
More Health Plans, such as Anthem Blue Cross are changing their PPO (Preferred Provider Organization), which traditionally has come with Out of Network Benefits to more Narrow Networks, such as their EPO (Exclusive Provider Organization), which do not have Out of Network benefits.
What this means to you, the patient - is your provider may not be part of Anthem's EPO Narrow Network and if you see them, you will have to pay out of pocket for all services. Please double check with your Plan Administrator to find out if your provider(s) are part of your new plan. Even if you have been seeing your provider for years, things can change without you being advised.
For providers, it would be a good idea to check with all your contracted payers come January 1st to see if they have created other networks you are no longer contracted with. You will need to ensure your front office staff is trained to check eligibility for each patient who has a commercial health plan - even if you have seen them for years, you could no longer be contracted with their current plan and your claims will get denied.
MEDELECT, Inc. offers services to both providers and patients to verify eligibility and benefits, which can help navigate your plan. Contact us at 877-543-2824 for more information.
Watchdog groups like this one in California are already filing lawsuits against Anthem Blue Cross for doing just this. For more details visit: http://www.kcra.com/article/lawsuit-insurer-anthem-misleading-california-customers/8075191