Patients enrolled in Anthem Blue Cross of California may be in for a rude and costly awakening the next time they visit a physical therapist, according to the California Physical Therapy Association, Sacramento, Calif, which notes that the insurance company is slashing payment for physical therapy services to a rate so low it is financially impossible for many physical therapists to continue providing care to enrollees of Anthem Blue Cross.
"Physical therapists are concerned that Anthem’s dramatic and unilateral reduction in payment will have a substantial effect on the quality of care being provided, as well as the ability of therapists to continue to participate in Anthem’s network," said Cheryl Resnik, PT, CPTA president. "We find it fundamentally unreasonable for Anthem Blue Cross to jeopardize the treatment of its enrollees by choosing to make such a drastic policy change. We are asking them to reconsider, but there seems to be no move to do so. Physical therapists have been met with a ‘take-it-or-leave-it’ response from the carrier."
Communications sent to providers indicate that effective March 1, Anthem Blue Cross will modify the current payment policy to a per diem model. When that goes into effect, physical therapists will experience up to a 50% reduction in payment for all treatment regardless of the intensity, duration, or degree of care provided. This severe rate cut, coupled with rising practice expense costs, will make it financially impossible for many providers to offer care to Anthem Blue Cross members under this arrangement, says the Association. The move by Anthem Blue Cross hits PTs from all sides, according to the Association: as employers, they are experiencing increases in premiums of up to 39%; as patients, they are experiencing decreases in coverage; and as providers, they are being paid substantially less to provide the same level of care.
"By lowering the boom, Anthem’s proposed action will likely have a substantial impact on its beneficiaries, especially those most vulnerable," said Stacy DeFoe, executive director, CPTA. "It is difficult to imagine that this move will not detrimentally affect access to care to the full realm of rehabilitative and wellness services provided by physical therapists. It could also delay the resolution of many patients’ conditions."
The California Physical Therapy Association urges consumers of health care to write directly to Anthem Blue Cross and inform the insurance company of the potential impact on their access to physical therapist services. Send letters to the Director of Network Management, Anthem Blue Cross, 21555 Oxnard St, CAAC08-08A, Woodland Hills, CA 91367.
[Source: California Physical Therapy Association]