Anthem sent letters to providers under contract with the Anthem Blue Cross Prudent Buyer Plan announcing changes to their fee schedule effective 7/1/19. Though the letter indicates the changes are necessary to allow greater reimbursement for primary care and E & M services they don't indicate that many high volume anatomic pathology services are subject to significant reductions As much as 50-60%. The Prudent Buyer Plan has 8 geographic regions so the specific reimbursement amount can vary slightly but here are some examples of the impacted AP codes and how the proposed rates compare to Medi-Cal and Medicare payment rates;

If you are a participating provider with Anthem Prudent Buyer Plan and have not received a letter and attached fee schedule you should contact the Network Relations Staff at [email protected]. Here is a link to the fee schedule and you will find the pathology codes beginning on page 110.

 

The CSP is in contact with Anthem and the Department of Managed Health Care over the magnitude and impact of these proposed reductions. In light of AB 72 on out of network physicians and a methodology for reimbursement this type of action by a major health plan will only exacerbate the prospect of pathology groups not agreeing to contract. That bill also requires monitoring of plan network adequacy.

 

We will update our members as we gather additional information.