Author Topic: Need help OPTING OUT of Anthem and BCBS CareFirst  (Read 1299 times)

debfini

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Need help OPTING OUT of Anthem and BCBS CareFirst
« on: June 03, 2014, 02:36:03 PM »
I know this sounds totally bizarre, however, I have been spending far too many hours researching this topic.  Nowhere in our contracts do we have anything that remotely correlates to opting-out.  I called the rep and followed her advice with no luck what-so-ever.  No letter returned to us.  Nothing. 

I bill mental health only and this particular provider decided to give it a shot last year (over 12 mo's ago).....well she is not happy and has been requesting to get out of these contracts.  I feel like an idiot.  Well, guess I really should not because none of the therapists I handle take insurance.

I know there is a change form  151 - however, that is what I sent in before with no such luck.  Just wondering if any of you "seasoned" billers" have some insight or know something about this topic?  Many blessings if you do! :-[

Thanks,

Debbie

Debbie Gilbert
Ashburn, VA

RichardP

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Re: Need help OPTING OUT of Anthem and BCBS CareFirst
« Reply #1 on: June 03, 2014, 07:29:53 PM »
The link takes you to a contract with Anthem of Virginia.  Note Point 8.2 on Page 16.  I can't find a date anywhere so I have no idea whether this language is currently valid.

http://www.anthem.com/provider/va/f4/s0/t0/pw_e188276.pdf

Either party may terminate this Agreement or Provider's participation in a Network(s) without cause at any time by giving at least one hundred twenty (120) days prior written notice of termination to the other party, except as otherwise provided in section 9.1 of this Agreement.

Here is an Anthem of Virginia website.  See Point IV (B)(3) on Page 5.  It is the same basic language as that found at the first link.

http://www.anthem.com/provider/va/f4/s0/t0/pw_m008661.pdf?refer=ahpprovider&state=va

Either you or we may terminate this Agreement for any reason by giving the other party one hundred twenty (120) days prior written notice of termination.

Does this help at all?

I presume that written notice of termination would be valid if sent to an official mailing address of Anthem of Virginia, with signature of receipt requested.  But this is probably an issue where it would be worth the small amount paid to check with a health-care attorney familiar with Virgina law.

PMRNC

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Re: Need help OPTING OUT of Anthem and BCBS CareFirst
« Reply #2 on: June 04, 2014, 03:32:33 PM »
In the last few years I feel like I've taken providers OUT of more networks than put them in.. can't blame them.

MOST BCBS contracts are 2-4 years... hopefully when she was credentialed they had that clause removed. I always caution all my clients when credentialing with BCBS to watch their term times. That is 2-4 years from the first official notice of opt out. Now you can go and search out all of the forms online, dozens of links, etc..but simplest way is to contact provider relations and ask them for the mailing address and OPT OUT PROCEDURE so your attorney can draw up the opt out paperwork from all of their networks. You probably don't need attorney but it sure does help things when you mention one. <g>
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

debfini

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Re: Need help OPTING OUT of Anthem and BCBS CareFirst
« Reply #3 on: June 05, 2014, 01:32:34 PM »
Thank you both so much for your help....I too found some of this online.  However, it is SO vague on how to opt out.  Her contract, thank the Lord, was for 1 year!  Again, thank you and I did think already that if I was to mail something, I would send it certified!! Indeed!

Sincerely,

Debbie

Debbie Gilbert
Ashburn, VA