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1) Site of Service Question

Under our current structure, we have in network and out of network labs and imaging centers.   In the out of network facilites, POS patients pay 20% co-insurance, POE patients pay 100%   When we go to Site of Service, the same providers are out of network as now.    The difference is the co-insurance for POS folks now goes to 40% for those providers.   POE folks of course see no change and pay 100% if they go out of network.

 

In network facilites, which are of course statewide and well over 60% of total facilites, are currently at 100% coverd  for POS and POE.    This is where the new classification takes effect.   Preferred in-network facilities remain 100% covered.   Non-preferred facilities drop to 80% covered.    Anthem has confirmed that the non-preferred tier is made up solely of hospital based labs and imaging facilities.   All other facilities, including physician based facilities will remain at 100% covered.

 

Again this information will be in the TA, and we'll update the Q&A.   But I wanted to share it all because obviously it is helpful to members who might be concerned.

 

Finally, please note that we have already updated the Healthcare Q&A to answer the question about out of area Site of Service (ie.g., I retire and move to Florida, will I now have to pay for my lab work?).   Our plan includes provisions that say that when we can't duplicate network access out of state, the patient can't be harmed.   So Anthem or United could have an equivlent program in Florida, etc., in whiich case the member or reitree would follow the same rules.   Or it could not, in which case the current rules would apply if the State has an equivalent lab network but without Site of Service, or all labs would be 100% covered if the state has no lab networks at all.