Anthem Blue Cross and Blue Shield

PG232173

the teeny-tiny network of Anthem Blue Cross and Blue Shield

Anthem and Cigna are planning a merger. Anthem had already merged with Wellpoint, by far Ohio’s largest insurer, in 2004. In 2014, Wellpoint changed its name to Anthem. It goes by Community Insurance Company on the rate filings.

Here in Ohio, Anthem is especially after Cigna’s Medicare Advantage business. These two companies are the largest members of the health insurance industry’s lobbying organization, AHIP, which is now headed by the Centers for Medicare and Medicaid Services’s former Administrator, Marilyn Tavenner. Talk about a conflict of interest. Marilyn Tavenner was the one responsible for the Marketplace’s disastrous rollout in the Fall of 2013. And what a small world it is — United Health’s Andy Slavitt took her place at CMS. Here is an interesting discussion on Physicians for a National Health Program’s website.

The health industry seems to be slowly creating its own single-payer system, one that will ensure massive profits for many years to come for these players — Anthem, Aetna, United Health, Centene (our Ohio Buckeye Ambetter) and Molina.

a perfect example of why health insurance company mergers are
bad news

Anthem is the most expensive plan sold on the Marketplace in Toledo. You have to be rich to buy it, but even so, buyer beware — you might not be getting a doctor.

Anthem is the granddaddy of the micro-narrow network. They’ve blessed us with only 36 PCP doctors, which is maybe 6% of Toledo PCP doctors, for our population of over 300,000, that has about 450 PCP doctors, but only 13 are actually accepting new patients. Nevermind that they advertise that 36 are accepting new patients, Anthem can do no wrong. In reality, they are giving us a choice of only maybe 2% of Toledo PCP doctors. What you see is not what you get, but Anthem is above reproach. We lowly Toledoans have to accept that and be grateful, because Anthem is almost holy in the eyes of our government and regulators. They must see something we can’t see, but they don’t see what we see. They have their own employee insurance.

Ohio Citizen Rate Review Provider Network Survey, Summer, 2016
Ohio Citizen Rate Review Provider Network Survey, Summer, 2016

13 not 39!

and look at that price….

These are the only eight internal medicine primary care physicians on Anthem's provider network they advertise are accepting new patients. But when you call them, they tell you that they are not accepting new patients.

In the healthcare.gov screenshot of Anthem’s gold plan above, all eight internal medicine primary care physicians in the provider network are shown as accepting new patients. I called each one of these doctors, and four out of the eight told me that they are not accepting new patients. This is false advertising, misleading, inaccurate, untruthful, and reckless for Anthem not only to present us with such a very small network to begin with, but to lead us to believe that it is actually open to us.

In November 2015, California fined Anthem and Blue Shield $250,000 and $350,000 respectively for their “unacceptable inaccuracies” in their provider directories, and they will be paying millions of dollars in damages to the members as well. Read the details here. My survey shows major flaws with Anthem’s provider directory in Toledo. Did the California provider network directory scandal even faze Anthem Blue Cross and Blue Shield of Ohio even a single tiny smidgen bit?

the birth of Anthem’s skimpy provider network

“How do I know if I am participating in one or more of the networks?” the doctors ask Anthem…

Doctors don’t join the Anthem network, they are put into the Anthem network without even being aware. Without being asked! The boldest of Orwellian schemes.

PG204294
Thank you doctor, you were the only one I could find who is accepting new patients!

How would you like to be a doctor and always have to know all the ins and outs of networks, that an insurance company like Anthem can put you in, or not?  See, this Anthem instruction to doctors. Think of the money that could be saved on healthcare if we could delete these time-wasting, manipulative administrative rules that have nothing to do with healthcare and everything to do with getting in the way of healthcare, so they can make more money.

Patients should be allowed to see any doctor who will take them. We could do this if we could get legislators to enact an “any willing provider” clause in our insurance laws, that would make our insurance portable, so that we could go to a provider willing to accept us who is willing to accept the insurer’s payment terms.

Why should insurance companies be allowed to create arbitrary networks which are not serving the purpose of containing costs for the members, which, 35 years ago, was the original reason for creating networks — but that have morphed into the negative effect of controlling utilization and causing bankruptcies, thereby working against the best interests of the members?

As we look back at what has happened since 2013, we can find many examples of surprise out-of-network bills and an entirely new way that insurance and maybe even providers limit our care to the detriment of our health, and at great expense! Surprise billing is the number one cause of medical bankruptcies, which have increased dramatically in the past five years. Healthcare costs are the biggest cause of bankruptcies in the United States.

Below is an excerpt from an Anthem Blue Cross and Blue Shield of Ohio letter to doctors in 2013. Anthem is giving information to doctors on the new healthcare.gov insurance, saying that the networks are “more focused,” and to log on to the network directory in October to see if their name is on it.

Screen shot 2016-07-30 at 3.36.46 PM

HOW WE CHOOSE DOCTORS AND HOSPITALS FOR OUR NETWORKS

Before providers join our networks, we check to see that they have the education, licenses and training to provide care. While we don’t have specific quality, member satisfaction or patient safety measures for selecting providers and hospitals to participate in our Marketplace networks, we monitor and promote quality of care within many of our networks using programs like Enhanced Personal Health Care (EPHC), Quality-In-Sights®: Hospital Incentive Program (Q-HIP®), Blue Distinction, Blue Physician Recognition, Blue Precision, Physician Quality Measurement (PQM), Anthem Quality-In-Sights®: Primary Care Program (AQI).

This from the Anthem provider directory preamble on what they tell their members.  Hmmm….even more Orwellian, all those programs. They have to find something to spend all that extra commission on that they make from our health insurance dollars — skimming 20% for themselves every year, their administration budget and profit growing at the same rate as the annual premium hikes. Wish my savings would grow so fast. But the bank crisis bailout of 2008-2009 took care of that. Even with all this extra money insurance companies make, they still can’t get the hang of keeping up to date with their teeny tiny micro narrow provider network database. Only 13 PCP physicians — you’d think they’d be real tight and in touch with their tiny cast of doctors through one of their nifty programs like Blue Distinction or Blue Precision, or Anthem Quality In Sights. But Anthem has no insight.

Read more here, about the birth of the narrow network: Less Choice, Lower Premiums: Many exchange plans will offer narrow networks.   What a joke — “lower premiums!” Which goes to show, it matters little what they say — they just do whatever they want, anyway.

Here’s an article about the “any willing provider” clause:  AHIP seeks reversal of “any willing provider” clauses.

how other Toledo provider networks stack up to Anthem:
Ohio Citizen Rate Review Provider Network Survey, Summer, 2016
Ohio Citizen Rate Review Provider Network Survey, Summer, 2016

Anthem Blue Cross Blue Shield PPO Rate Review

It’s ironic that Anthem is the most expensive insurance sold on the Marketplace, yet it has the smallest of any network.

Anthem has a membership of 40,000 covered lives in Ohio, which is about an 18% share of the Marketplace. The Toledo area membership is undisclosed.

Anthem is asking for a 9.9% average rate increase for 2017, with the increases ranging from 3.4% to 20.3% depending on how unlucky you are. So your $1,845 premium plan in 2016 could very well be $2,300 in 2017, with the age factor figured in.

When premiums go up so much compared to other plans that only the sick spring for the extra bucks because the plan has something special, that is what is called a death spiral. But with Anthem’s micro-narrow provider network, there’s really not much that Anthem Blue Cross and Blue Shield has to offer to the sick.