Anthem Blue Cross of CA Leaving Members In The Lurch

Beginning Monday, February 1, 2010, many Anthem Blue Cross members may have more difficulty finding physical therapists willing to treat them. A situation resulting from a "cost restructuring" move by the insurance company.

In November 2009, a letter was sent out by Anthem to all the physical therapists, occupational therapists, and speech therapists in its network, telling them that they would be switching to a flat fee rate of reimbursement of $75 per visit in February 2010. Depending on the services provided, this represented a 25-200% reduction in the reimbursement rate.

These rates are an absolute insult to these 3 allied health professions. I know personal trainers at gyms, with less education, that get paid more for 1-hour sessions. Why should medical professionals with advanced degrees be reimbursed less? In my opinion, these drops in reimbursement set a dangerous precedent because there will likely be 2 outcomes:

1) Good therapists wanting to devote time and quality care to their patients, will have to opt out of the network. This means that patients that want to see them, will have to bear more of the burden of the expenses.

2) Therapists that remain in the network will likely shorten time patients get with licensed PT's and use more aides/assistants to administer care. They may also begin to double book patients to try and increase productivity of their staff members. This will result in a significant drop in the quality of care and less than optimal outcomes for patients.

The bottom line is this "restructuring" will result in significant ramifications to both Blue Cross providers and patients. Throughout this process the last few months, Anthem Blue Cross has held steadfastly to the claim that this new fee structure will actually save their patients money. They have tried to justify their position by stating that decreased reimbursement to therapists will result in decreased out-of-pocket expenses for their patients. At our facility, we have already seen other insurances forcing patients to pay a co-pay/co-insurance ($40) higher than the reimbursement amount the insurances are paying ($35). Why should you the patient be paying more than the insurance company? What is your insurance premium going towards? Why should you have to pay higher premiums and higher visit costs?

The most disturbing aspect of this decision? Wellpoint, Inc., Anthem Blue Cross' parent company, posted 4th quarter net income for 2009 at $2.7 billion. A meteoric rise from $331.4 million from a year ago. Wellpoint says they are expecting continued growth and CEO Wayne DeVeydt is quoted as saying, "Our insurance subsidiaries remain well-capitalized and we continue to generate substantial operating cash flow." So why the need for higher patient premiums and cuts to provider reimbursement? You can read more about it here.

Though they are the most recent, Blue Cross is not the only insurance provider to change it's reimbursement methodologies and shows us why third-party payers fear a national health care reform that would challenge them for members.

While we wait for our leaders in Washington to come to an agreement on new policy, there are some things that you can do to preserve the quality and affordability of your health care.

• Write a letter to Blue Cross representatives and voice your concerns. A sample letter and contact list can be found on the More Physical Therapy website here.
• Write, call, or email California insurance officials and express your concerns. A list can be found again on the More Physical Therapy website above.
• Contact members of Congress with your concerns using the email forms provided by PTPN's Political Action Center.
• Contact your HR department and express your dissatisfaction with Blue Cross and the fact that you may be paying higher premiums for more limited access to providers.

At Elite Sports Physical Therapy, we know that we will not be able to continue to provide the standard of care that we would like at Blue Cross' new reimbursement rate. We are still evaluating our current situation and will keep all of our patients (current and future) apprised of our contract decisions.

If you have any questions feel free to contact us at 510.656.3777 or continue checking our website at www.espt-ca.com for updates.

Thank you for your understanding and support.