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Non-network Acupuncturists to be Paid as Non-Network

Oct 02, 2009

Effective January 1, 2010, Anthem Blue Cross will begin paying for covered services based on non-network benefits as stated in the member's Evidence of Coverage (EOC). Previously, non-network acupuncturists were reimbursed for covered services based on network (contracting) benefits.

Anthem Blue Cross will be sending a letter to members who have been seeking care from non-network acupuncturists. The letter informs them of the change and reminds them that Anthem Blue Cross has an extensive provider network. With over 53,500 health care professionals in our California network, there are many excellent provider choices; members can locate network acupuncturists by going to anthem.com/ca and selecting Find a Doctor.


Sample cost comparison


Anthem Blue Cross knows there are various benefit plans. For simplicity's sake, and to see the impact of this change, let's say you have an 80% benefit plan in network and a 60% benefit out-of-network. Here's how the out-of-pocket costs would differ between a network and a non-network acupuncturist:

 

Network

Non-Network

Amount charged by provider

$50.00

$50.00

Amount allowed by Blue Cross

$50.00

$50.00

Plan pays 80%/60% of amount allowed

$40.00

$30.00

Member pays

$10.00

$20.00*

 
As you can see, a member will pay more for a non-network acupuncturist.


Member costs increase with out-of-network health care

PPO benefits offer flexibility for seeking out-of-network (non-network) health care, but they also increase the member's share of the costs. You might also remind clients that since Anthem Blue Cross has no contract with these providers, the provider may still bill them for the difference between what Anthem Blue Cross pays and their billed charges. By staying in-network, members can avoid these higher out-of-pocket costs, avoid claim filing paperwork and gain a health care advocate for appropriate, cost-effective care.

*Charges over the Amount Allowed do not apply toward the Out-of-Pocket Maximum. 
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