Many physical and occupational therapists and speech-language pathologists who contracted with Anthem Blue Cross in California may pull out of network after Anthem instituted a rate-structure change the therapists say they can't afford.
According to a report in the San Jose Business Journal January 29, the change would offer the therapists $75 per visit. Depending on the provider, the reduction amounts to anywhere between 25 percent and 200 percent less in therapy reimbursement for Anthem patients.
"My take is that if we agree to these changes, we're giving permission to the insurance companies to say our services aren't worth very much," Ross Nakaji, CEO of Los Gatos Orthopedic Sports Therapy Inc., told the Journal.
The paper reported that some 2,000 therapists now contracting with the Physical Therapy Provider Network, one of the largest providers in California, would effectively have to sign on with Anthem as independent contractors. PPPN, which first contracted with Anthem last fall, was paid a basic fee-for-service at the rate of about $90 to $140 a visit. The new payment structure bypasses the network. But it doesn't apply to therapists who work in physicians' offices.
The new fee schedule will take effect Feb. 1st. But all three disciplines met last week with the California Department of Managed Health Care, charging Anthem and its parent company, Wellpoint Inc., with restricting access to care through its new payment structure. The company could be fined if it is indeed found to be doing that.
"No. 1, this impacts the client," Shawn Phipps, president of the Occupational Therapy Association of California, told the Journal. "Their reduction in reimbursements amounts to therapists basically opting out. There are going to be less therapists available to those who need the care, and the ones left are the bottom of the barrel who will take anything."
Anthem in turn says that it can't afford not to reduce therapy rates. The cutback will reduce premiums for its members. But Dave Lemire, CEO of Quinn Orthopedic Physical Therapy in Cupertino, told the Journal, "Come Monday, I don't know what they're going to have for a provider network. They're going to be stuck with all of these covered patients that don't have a place to go for. therapy. All of my patients that are trying to find a network provider are being told there are no network providers."