From email I received this morning:
"Kettering Anesthesia Associates, which serves [various providers in the Dayton, OH area], has chosen to terminate its provider contract with Anthem ... Consequently, Anthem members may be billed by Kettering Anesthesia Associates for any balance not covered by Anthem"
This is SOP when dealing with network-based plans: with some exceptions, providers are barred from "balance billing" their patients for amounts written off as discounts. The big problem here is that PARE providers generally have an exclusive relationship with hospitals; that is, if you're going to be "put under" at (for example) Kettering Hospital, you don't have a choice of gas-passers. If they're not in-network, they can bill you pretty much anything they want, and you're on the hook.
[As an aside, I was quite surprised to learn that KAA was even in a network: that's highly unusual]
On the plus side, I must commend Anthem for recognizing this:
"[S]ince our members do not have a choice of anesthesiologists for surgeries performed at Kettering Medical Center, Anthem will apply the equivalent of any member liability amounts such as co-payments, deductibles, etc., at the member’s in-network level (rather than the out-of-network benefit level equivalent). In most circumstances, payment for services will be issued to the member"
Two things of interest here: first, that they'll essentially continue to treat these claims as in-network, so as not to penalize their members. Second, I love that they're going to send that balance due amount directly to the insured. This accomplishes several things: it increases patients' awareness of just how much their health care costs, and it also puts the onus on the provider to collect whatever's due (something we mentioned almost 7 years ago).
Kudos to Anthem on a clever and effective solution to what could have been a major snafu.
[Hat Tip: Beth D]
"Kettering Anesthesia Associates, which serves [various providers in the Dayton, OH area], has chosen to terminate its provider contract with Anthem ... Consequently, Anthem members may be billed by Kettering Anesthesia Associates for any balance not covered by Anthem"
This is SOP when dealing with network-based plans: with some exceptions, providers are barred from "balance billing" their patients for amounts written off as discounts. The big problem here is that PARE providers generally have an exclusive relationship with hospitals; that is, if you're going to be "put under" at (for example) Kettering Hospital, you don't have a choice of gas-passers. If they're not in-network, they can bill you pretty much anything they want, and you're on the hook.
[As an aside, I was quite surprised to learn that KAA was even in a network: that's highly unusual]
On the plus side, I must commend Anthem for recognizing this:
"[S]ince our members do not have a choice of anesthesiologists for surgeries performed at Kettering Medical Center, Anthem will apply the equivalent of any member liability amounts such as co-payments, deductibles, etc., at the member’s in-network level (rather than the out-of-network benefit level equivalent). In most circumstances, payment for services will be issued to the member"
Two things of interest here: first, that they'll essentially continue to treat these claims as in-network, so as not to penalize their members. Second, I love that they're going to send that balance due amount directly to the insured. This accomplishes several things: it increases patients' awareness of just how much their health care costs, and it also puts the onus on the provider to collect whatever's due (something we mentioned almost 7 years ago).
Kudos to Anthem on a clever and effective solution to what could have been a major snafu.
[Hat Tip: Beth D]
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