Blue Shield of California Providers --Important Notice!
"Why Did I Get a New Contract from Blue Shield of CA?"
By Barbara Griswold, LMFT (July 30, 2012)
Confusion was the order of the day this week when Blue Shield of
California providers received new contracts in the mail. I
interviewed a representative from the Blue Shield Provider Contracting
Team, and here were his responses.
"Why are we getting new contracts?" BS
gave these two reasons: 1) For simplification, to put all providers on
the same contract, and 2) in response to the Affordable Care Act (aka
healthcare reform), BS will be coming out with three new plans (BS
Network A, B and C in on pages 21 and 24 of the contract). To
compete with other insurers in this new insurance marketplace, these
plans will be discounted to various degrees.
"What does this mean for me?" In
addition to the "standard" BS plan you are now contracted
with, you have the option to become a participating provider for some --
or all -- of these new plans. When you see members from the new
plans, you would receive 10% - 30% less than your current reimbursement
rate, depending on the plan (as outlined on Page 24). Or you can
just continue to provide care only for clients on the
"standard" network, for your current contracted rate. I
repeat: According to Blue Shield, this contract does not represent a
change in rates for clients who have the current, standard commercial BS
PPO, EPO, or HMO plans.
"Why join the new plans and accept a discount on my
already discounted rate?" Says BS: "Many
formerly uninsured clients will be enrolling in one of the new
plans. Also, a current client may switch over to one of the new
plans, and you would no longer be a covered provider."
(However, the representative admitted, you could always join the
client's network at that time, which should not be any problem since
you are already a BS provider.)
"Can I negotiate the reimbursement
rates?" No, according to BS.
"I am not an eligible provider for Medicare and/or Healthy
Families. Why are these listed plan options?" These
options are for eligible providers only, and does not mean you were now
"How does Magellan figure into all this?"
Magellan/HAI manages most (but not all) of the mental health
for BS of CA members. For this reason, providers are being urged to join
Magellan. But according to BS, this new contract does not affect your
Magellan contract or compensation rates.
"What am I being asked to do?" ALL
Providers are being asked to:
Read the contract, and sign and date it on page 20.
If you wish to participate in ALL of the new (and future) networks
that you are eligible for, at the various compensation rates outlined on
page 24, choose #1 on page 21.
If you wish to "opt out" of some or all of the new plans,
choose #2 on page 21. REMEMBER: ONLY CHECK BOXES FOR THE PLANS IN WHICH
YOU DO NOT WANT TO PARTICIPATE.
Fill out page 22 (and 23, if applicable).
Return all pages of the original signed agreement (pages 1 - 24) to
Blue Shield. I recommend you keep and file a copy of the entire
completed, signed agreement.
Still have questions? Call Provider Services at 800-258-3091 and
choose the star sign (*). You actually should get a live person!
Sound like things are getting more complicated? You
betcha. When a client says she has BS of CA, it has
always been important to find out whether she is a "straight"
BS client (handled directly by BS), or one handled by the BS Mental
Health Administrator du jour (formerly USBH, now Magellan). But
now if you choose to opt out of any plans, you will need to be sure at
the start of therapy that you are a provider for the client's
particular BS network. Yet another reason to call up front.
(Stay tuned for updates....)
Barbara Griswold, LMFT is the author of Navigating the Insurance
Maze: The Therapist's Complete Guide to Working With Insurance
-- And Whether You Should (Third Edition), available at www.theinsurancemaze.com.
In addition to her private therapy practice in San Jose, CA, she teaches
insurance classes and consults with therapists nationwide to assist them
with their insurance problems and questions. She welcomes you to
contact her at www.theinsurancemaze.com.