Important Information for Anthem Blue Cross MembersOctober 07, 2015
ATTENTION ANTHEM BLUE CROSS PATIENTS
Anthem Blue Cross has made a MAJOR CLINICAL POLICY CHANGE that will have a negative impact on your ability to receive physical therapist services.
Starting November 1, 2015, OrthoNet will manage all outpatient physical therapy services for Anthem Blue Cross of California. OrthoNet is a third party network supplying utilization management for all therapy services provided to all Anthem members. Currently, you are able to use your physical therapy benefits included in your plan without preauthorization.
On November 1, 2015, this will not be the case. After the initial therapy evaluation, providers must request prior authorization for the outpatient physical therapy services.
- This will cause delay in physical therapy services as well as limit how much care you may receive.
- The amount of care you receive will no longer be decided by your physician and physical therapist.
- This will be determined by someone in an office at OrthoNet who is not familiar with your case and who may not be a medical professional.
Anthem sent a letter to their members announcing this change. California Physical Therapy Association and its 8,000 members find the content of the letter severely misleading and unwarranted.
The letter claimed the following:
- A physical therapist or physician independent or in consultation with each other are incapable of determining when physical therapy is medically necessary.
- Anthem enrollees are confused by their physical therapy benefits.
- All outpatient therapy will be managed by a third party administrator that has limited medical knowledge of the patient. This means that someone other than your physician and physical therapist who does not understand your case will determine how many treatments you receive.
We NEED your help in advocating AGAINST this change:
- Immediately speak with your employer or plan benefit administrator.
- Explain the potential impact of this action with your Anthem Blue Cross Member Services representative.
- On or after November 1, you may file a grievance of access with Anthem Blue Cross at the number listed below.
- Individual Plan Members: (800) 365-0609
- Employer Group Plan Members: Call the number on the back of your Member Identification Card
The California Department of Managed Health Care (DMHC) is responsible for regulating health care service plans. For a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call DMHC for assistance. The department can be reached at (888) HMO-2219 or by e-mail at firstname.lastname@example.org.
Thank you for assisting us in helping you receive the care you need.
If you have any questions or concerns, please email us at email@example.com or give us a call at 714-256-5074.