Anthem has taken a lot of heat for their recent transition from PPO to EPO… And it’s easy to understand why.
When your family’s health coverage is about to change, this isn’t something most peolple take lightly… For good reason! We are, after all, talking about the health and welfare of you and your family.
Like a lot of things, however, change isn’t always as disruptive as it may seem initially.
In this post, we’re going to clarify the basics of this transition, and walk through some practical takeaways for current Anthem Blue Cross of California policy holders.
First, let’s clarify the basics of Anthem’s transition from PPO to EPO for 2017. In doing so, we hope you’re able to make a more informed decision on your coverage: Whether you plan on sticking with your current plan, or looking at new options.
EPO stands for Exclusive Provider Organization… PPO without the out of network benefits.
Although it’s too early to tell, it’s only reasonable to think that EPO in-network benefits will be very similar to the in-network benefits of Anthem’s prior 2016 PPO plan.
This means that it functions exactly like a PPO plan, as long as you stay in-network. Out of network, however, will be up to you. This means out of network specialists and doctors will simply be paid cash. Ultimately, this can be to the benefit of the consumer in many instances, as cash discounts can often be heafty…
Here’s the funny thing: How often does a typical PPO policy holder go out of network? Almost never.
Out of network benefits examined:
Out of network services are extremely expensive on virtually all PPO plans, with all carriers. (barring out of network emergency care, which is now covered on all health plans as part of the 10 essential health benefits under the ACA.)
With all of the above in mind, Anthem is urging current policy holders to consider the reality of the PPO to EPO transition on their desired doctors, hospitals, and specialists.
If you’re used to the in-network access under Anthem’s 2016 PPO plan, chances are, you’re going to be completely fine on the new EPO. In fact, if you’ve been an “individual family plan” holder for more than a year, you’ve already experienced the EPO network. 2015 was also an EPO network year for Anthem.
Anthem’s EPO seeks to retain the vast majority of top doctors, specialists, and facilities in Southern California, including top-tier options like UCLA, Cedars, etc… And new facilities are being added every day.
One big positive:
Anthem’s EPO plans still feature access to their unparalleled “Blue Card”. Anthem’s Blue Card allows plan holders access to the full Blue Cross/Blue Shield combined PPO network, on a national scale. This gives Anthem EPO members in California access to the largest PPO network in the nation: This is perfect for students away from home or while traveling. Some of our clients even use this opportunity to research top out of state providers like specialists, labs, and hospitals, then have services rendered when it makes sense. As an example, you might have a particular condition, and want the very best service possible. If a foremost expert in that field is located in another state and is part of the Blue Card system, you would be treated as in-network for all covered services.
Anthem has not completely revealed what this network is going to look like. This is mainly because it takes time for doctors, hospitals, and specialists to review the new contracts, sign up, etc…
In “mid-January”, Anthem will have updated their systems to reflect the new network. At that time, the EPO will show in their system, and you can run a search by clicking here to Anthem’s search tool.
Select each option as follows, and complete by selecting an EPO option on the last drop-down menu: Click here for a screenshot.
Another great option is to simply call your doctor directly and ask them. Even if they have not completed their contracting paperwork with Anthem, they may be able to let you know if they’re planning on participating. We’ve seen this type of transition before: The carrier offers the new terms, the service provider accepts or negotiates the deal, etc…
You have time:
Time is on your side: 1/31/2017 is the last date to make a change to your Anthem plan. With this being the case, it might make sense to give this transition a month or two. Although changes made Between Jan 16 and Jan 31 will result in an effective date of March 1st, this will give you time to talk with service providers, consider your options, and make the best possible decision for your household.