Author Topic: BCBS Exchange Marketplace Plans  (Read 2564 times)

Christy

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BCBS Exchange Marketplace Plans
« on: August 19, 2014, 12:14:06 PM »
http://www.physicianspractice.com/blog/how-healthcare-payers-are-tricking-practices-poor-contracts?GUID=9533E9BE-E642-4774-9B8C-7106375F772C&rememberme=1&ts=22042014

Hello all,

Please see the link above. One of my clients has received "the letter" stating that he is automatically in network with the BCBS exchange plans in NY. I just emailed our provider rep for a fee schedule.

Does anyone have a similar experience as the link above states?

thank you!

PMRNC

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Re: BCBS Exchange Marketplace Plans
« Reply #1 on: August 19, 2014, 02:40:22 PM »
If you currently have a provider contract with an "all products clause" you are automatically participating with all BCBS NY products. Read your current BCBS contract.   The letter is basically a reminder because in NY physicians are still telling patients they don't "accept Obamacare". I just did a great direct mail campaign about this and got quite a great response!!!

Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

PMRNC

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Re: BCBS Exchange Marketplace Plans
« Reply #2 on: August 19, 2014, 02:50:58 PM »
Also BCBS send a few reminders of this to providers back in 2012. I have letters dating from April 2012 and June of 2013. Providers were instructed to view contracts and product clauses.

Those who specialized in credentialing had a great market when this hit the fan.. I rode the wave big time and de-credentialed providers. The billing clients I do have with BCBS decided to stay since the fee schedule doesn't change among among our fees. Many physicians still are opting out based on principal.. It is really imperative that you have clients review contracts and make an informed decision based on a thorough analysis of the payers BEFORE making a decision to get out.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

shanbull

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Re: BCBS Exchange Marketplace Plans
« Reply #3 on: August 22, 2014, 03:51:38 PM »
If you currently have a provider contract with an "all products clause" you are automatically participating with all BCBS NY products. Read your current BCBS contract. 

This sounds more like the letter we received, which we were expecting and fine with. It's actually nice for us, with other insurers we have to request to be added to the new, narrower networks (one of which we only found out about because I bought the same plan on the network that 59% of people with new exchange plans signed up for - that is a LOT of business to be missing out on! See article here http://www.twincities.com/ci_25639151/preferredone-grabs-big-share-new-marketfor-health-insurance) so the way the  BCBS contract is set up means less work on our end.
« Last Edit: August 22, 2014, 03:55:15 PM by shanbull »

PMRNC

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Re: BCBS Exchange Marketplace Plans
« Reply #4 on: August 22, 2014, 05:40:59 PM »
There are so many myths being perpetrated about the exchange plans. I did a great direct mail campaign on this very subject and couldn't believe the responses I got. So many physicians are just blindly telling patients they don't participate with "obamacare". One of my pediatric clients was totally against the ACA but from a reimbursement point of view, we've had no trouble. We revised our patient payment policies and office financial policy to accommodate for the higher out of pocket plans too.  There is a physician here also not too far from me that is being sanctioned for not seeing patients without proper dismissal having to do with not taking "Obamacare".
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

shanbull

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Re: BCBS Exchange Marketplace Plans
« Reply #5 on: August 25, 2014, 10:12:57 AM »
That's really unfortunate Linda, our experience with the exchange plans has gone smoothly so far too. No delinquency in payments to us even for patients with high deductibles, and the reimbursement rates are better than Medicaid and Medicare (which we also accept). The only real issue we've had is needing to spend some extra effort on getting into the selective networks. And even that has been easy since we're an independent clinic with a lot of specialties insurance companies tend to want more of and it allows more patient choice to have more in-network specialists. The clinic owners were wary about "Obamacare" too at first, but they're business people first and foremost, and when they sat down and looked at the raw numbers, they were happy to accept the exchange plans. I doubt our doctors could say which patients have exchange plans anyway. All they want to know is if they can get paid the in-network rate or not.