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Anthem to require physicians to notify patients before referring out-of-network



February 25, 2013
Area(s) of Interest: Commercial Payors Patient Care Practice Management 

In late November, Anthem Blue Cross announced that it would soon begin requiring contracted physicians to notify patients in writing before making out of network referrals. Effective March 1, the payor’s new “Advance Notice for Use of a Non-Participating Provider Policy” (APN policy) requires this notice be given using the payor-provided APN form. The policy does not apply to emergencies.


While Blue Cross has included language in its contracts since 2008 requiring physicians to disclose to patients and document the same type of information included in the APN form, it was not often enforced.


According to Blue Cross, it frequently receives complaints from patients who were unaware that they were being referred to out-of-network providers. The payor says that its new policy is not intended to deter patients from using their out-of-network benefits. Rather, it is intended to help patients make informed decisions about their coverage and options.


The California Medical Association recognizes the administrative burden this new policy may place on physician practices and is in discussions with Blue Cross about ways to minimize this burden. Physicians with concerns are encouraged to contact Blue Cross Network Management at (855) 238-0095.

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