January 18, 2018
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement Practice Management
The California Medical Association (CMA) is reminding physicians that Anthem Blue Cross has exited California’s exchange marketplace in all but three regions for 2018. The impact of Anthem’s exit from the exchange is significant, requiring over 150,000 Covered California enrollees to select a new plan or face auto-enrollment in an alternative health plan during the 2018 Covered California open enrollment period ending January 31, 2018.
Although Anthem patients were notified of this change, CMA has heard a growing number of reports of Covered California patients presenting for treatment with their Anthem cards, apparently unaware that they were transferred to another plan.
While Covered California estimates that approximately 84 percent of currently contracted Anthem physicians will remain accessible to enrollees through another Covered California qualified health plan, a significant number of enrollees will be required to select new physicians under their new health coverage. Enrollees who have not selected an alternative health plan were auto-enrolled into the lowest cost alternative exchange plan available at the same metal tier.
Physicians who are contracted with other exchange plans and wish to retain their Anthem Blue Cross patients may wish to advise their patients of the other exchange plans they contract with, so patients can switch before open enrollment ends on January 31. (Click here for a sample patient notification letter.)
Patients may also be able to continue to see their physicians, even if they are not contracted with the patient’s new plan, under California’s continuity of care law. For more information on continuity of care requirements, see CMA On-Call document #7051, “Contract Termination By Physicians and Continuity of Care Provisions.”