ABCBS Reduces Reimbursement for Individual Market Plans

AMS has learned that the state’s largest insurance carrier, Arkansas Blue Cross and Blue Shield will reduce reimbursements to its provider network effective January 1, 2018.  The reduction applies only to the carrier’s individual metallic health plans (i.e. not group health plans), which include the Arkansas Works Medicaid expansion program.  The reductions apply to all network providers and will impact nearly 200,000 insureds or approximately 25% of the carrier’s insured customers.

Reimbursement for Evaluation and Management Services will remain unchanged. We understand that contract amendments are in the mail.  In a meeting with representatives of the company, they have cited, as the reason for the cuts, a shortfall on this block of business created by the Arkansas Insurance Department’s denial of the carrier’s requested premium hike in 2017 and state budget caps established for the Arkansas Works program.  The reductions are detailed in the contract amendment currently being sent out by the carrier.

AMS believes it is important that physicians understand their options in light of this, the third reimbursement cut in the last 4 years.  To our knowledge there are basically 3 options:

1. Do nothing and the contract amendment takes effect in January.
2. Resign from the ABCBS True Blue network entirely, which would mean out of network status for virtually all of your ABCBS patients.
3. According to our contacts at ABCBS, physicians also have the option to “opt out” of only the ABCBS individual metallic plans.  Opting out of the individual metallic plan product will not affect network membership in other ABCBS plans. As stated above, the carrier currently has nearly 200,000 individual metallic plan policies in effect.