February 06, 2011
Area(s) of Interest: Payor Issues and Reimbursement
The Department of Managed Health Care (DMHC) approved the physician networks in the remaining Blue Cross Healthy Families counties in January. With this approval, Blue Cross will no longer be required to offer a continuity of care plan.
Blue Cross has, however, agreed to extend the continuity of care plan through March 31, 2011, for patients in all counties except San Bernardino, Riverside and Orange. The continuity of care plan for those three counties expired Aug. 30, 2010. Effective April 1, 2011, all physicians will have to be in Blue Cross's Healthy Families network in order to get paid.
Blue Cross announced in March 2009 that it would require physicians to sign a separate contract and accept reduced rates if they wanted to continue treating Blue Cross-insured patients through the Healthy Families and Access for Infants and Mothers programs. The new lower payments vary but hover just above Medi-Cal rates.
As a condition of the network approval, DMHC required that Blue Cross provide 30 days written notice to both patients and physicians regarding the elimination of the continuity of care plan, which has allowed patients to see out-of-network physicians since September 2009.
Physicians who have patients currently undergoing a course of treatment and believe that transition of care to another provider could adversely impact the patient's care can contact Blue Cross Utilization Management at 888/831-2246 to request authorization for continued care as a non-participating physician.
Patients can locate in-network physicians by visiting the Blue Cross website or by calling the number on the back of their insurance cards.
Contact: CMA's reimbursement helpline, 888-401-5911 or email us.