Hard to believe, but we started discussing Anthem-provider network issues 7 1/2 years ago:
"When Premier's network contract with Anthem expired on Jan. 1, Anthem stopped paying Premier directly for services at Miami Valley and Good Samaritan hospitals ... Now Premier wants its money, taking legal action on what Shaw called "the most egregious cases."
Fortunately, Cincinnati-area Anthem insureds who receive care at the University of Cincinnati's facilities may dodge that kind of bullet:
"UC Health says it has agreed not to charge patients insured by Anthem Blue Cross and Blue Shield higher, out-of-network costs even if the hospital system and insurer don’t strike an agreement on reimbursement rates by an April 15th deadline."
It seems that their agreement is up in a week, and that's got some Anthem insureds a bit nervous - and based on previous experience, rightly so. But UC Health's Diana Lara says not to worry, because they "don’t want to put patients in the middle. We care about our patients and certainly don’t want them to have to endure the stress of having to interrupt a life-saving treatment or change their physician.”
So it appears that, at least for the nonce, UC Healh patients insured by Anthem can rest a little easier, knowing they won't get hit with major out-of-network charges.
That's the good news. Here's the potentially bad:
Benefits costs are only one part of the equation. Typically, hospital-based services are subject to deductible and co-insurance requirements. That is, they have an annual deductible to be met, and often some additional out-of-pocket costs. These are calculated based on whether a service is received in or out of network. If UC Health is out-of-network, then whatever amount an Anthem insured pays for services rendered is likely to be reduced when calculating deductible and co-insurance credit.
For example:
Anthem allows $100 for an earectomy at a network provider. Joe has a $1,000 annual deductible, he pays the $100 and has just $900 to go. But if Dr Smith is out-of-network, Anthem allows only $65 for an earectomy (under the "Usual, Customary and Reasonable" rates theypulled out of their... calculated). So Joe owes (and pays) Dr Smith $100, but only gets $65 credited towards his deductible. That could get real old, real fast.
[Hat Tip: FoIB Holly R]
"When Premier's network contract with Anthem expired on Jan. 1, Anthem stopped paying Premier directly for services at Miami Valley and Good Samaritan hospitals ... Now Premier wants its money, taking legal action on what Shaw called "the most egregious cases."
Fortunately, Cincinnati-area Anthem insureds who receive care at the University of Cincinnati's facilities may dodge that kind of bullet:
"UC Health says it has agreed not to charge patients insured by Anthem Blue Cross and Blue Shield higher, out-of-network costs even if the hospital system and insurer don’t strike an agreement on reimbursement rates by an April 15th deadline."
It seems that their agreement is up in a week, and that's got some Anthem insureds a bit nervous - and based on previous experience, rightly so. But UC Health's Diana Lara says not to worry, because they "don’t want to put patients in the middle. We care about our patients and certainly don’t want them to have to endure the stress of having to interrupt a life-saving treatment or change their physician.”
So it appears that, at least for the nonce, UC Healh patients insured by Anthem can rest a little easier, knowing they won't get hit with major out-of-network charges.
That's the good news. Here's the potentially bad:
Benefits costs are only one part of the equation. Typically, hospital-based services are subject to deductible and co-insurance requirements. That is, they have an annual deductible to be met, and often some additional out-of-pocket costs. These are calculated based on whether a service is received in or out of network. If UC Health is out-of-network, then whatever amount an Anthem insured pays for services rendered is likely to be reduced when calculating deductible and co-insurance credit.
For example:
Anthem allows $100 for an earectomy at a network provider. Joe has a $1,000 annual deductible, he pays the $100 and has just $900 to go. But if Dr Smith is out-of-network, Anthem allows only $65 for an earectomy (under the "Usual, Customary and Reasonable" rates they
[Hat Tip: FoIB Holly R]
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