ABCBS Adjusts Reimbursement for Individual Metallic Plans

Physicians and other medical providers are receiving contract amendments from Arkansas Blue Cross and Blue Shield (ABCBS) laying out how they plan to begin reimbursing for services under the new health care plans.  This information was shared with AMS staff recently.

The network affected by the amendments is the True Blue network and applies to “individual policies” written under the “metallic” plans, whether on or off the Insurance Exchange, including those eligible for the private option (alternative to Medicaid expansion).  It does not apply to current commercial policies or group plans.  The metallic plans are the bronze, silver, gold, and platinum plans created under the ACA.

Effective January 1, 2014, physician reimbursement (for ABCBS) for individual policies written under these metallic plans has been reduced by 15 percent for non-primary care specialties.  Primary care specialties will see no change in reimbursements from the current ABCBS fee schedule.

More details are provided in the contract amendments which many physicians have already received. As always, AMS encourages physicians to read contract amendments closely and make informed decisions regarding participation in any insurance network.