Measurable Solutions

Measurable Solutions asked one of their clients in California, Ida Hirst, of her experience with the rate reductions that Anthem has put forth.

"This has been a hot topic among practice owners since this only effects private practices, not hospital or physician owned clinics.  Many clinics have opted to terminate their provider relationships with Anthem BC.

I have decided to stay in.  A careful search through EOBs coming through my office finds that many of our PPO contracts and certainly our Work Comp visits are paying below the $75 per visit.  I then took an average of what we receive currently from our Anthem BC visits and found that due to the way they cascade for reimbursement that we have a hard time getting a significant amount more than this for the average visit if we are completely honest with our coding.  The only way to consistently get the good payment would be to perform the same procedure for a full 45 to 60 minutes every time.  This rarely happens.

I am not happy about this change, but it has spurred me to make decisions to gradually drop other low paying insurance contracts and to plug a way at converting to a cash based practice where people get a great service in a short amount of time for a very reasonable fee.  We will provide them with a super bill to submit directly to their carrier if they wish.  Unfortunately to drop Anthem BC would mean a drop in patient volume by almost 40% and we can not handle that dramatic of a change right now.  I am respectful of those practices who were able to either never depend on Anthem or are now ready to do so."

Ida Hirst
Pleasanton, CA