Anthem mistakenly lists almost 1,000 physicians as participating in individual/exchange network April 16, 2014 General Covered California, Health Insurance Exchange, Anthem Blue Cross 0 Anthem Blue Cross recently notified 965 physicians that they were erroneously listed as participating in the payor’s individual/exchange network. The April 9 notice states that affected physicians were “inadvertently” listed for “a certain period of time” during open enrollment. After receiving a number of complaints from physicians who believed they were listed inaccurately as participating in the Anthem Blue Cross individual/exchange network provider directory, the California Medical Association (CMA) contacted Anthem to discuss the matter. At that time, Anthem acknowledged the error and said that affected patients had already been notified. At CMA’s urging, Anthem agreed to also notify affected physicians. According to Anthem, affected physicians were paid at 100 percent of Prudent Buyer PPO rates for affected dates of service between January 1 and March 31, 2014. However, claims for dates of service on or after April 1, 2014, will be reimbursed as out-of-network. Anthem notified affected patients who had seen an out-of-network physician that they would need by March 31 to either select a new in-network physician or change to a different plan in which that physician participates or face higher out of pocket costs. The patient notice also advised them of their right to request continuity of care with the out-of-network physician. Questions about the error can be directed to Anthem’s Network Relations Department at (855) 238-0095 or networkrelations@wellpoint.com. Comments are closed.
