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Anthem Blue Cross Losing California Therapists

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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."


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Hi Chris & Maggie!

Thank you for your comments on the article published in the San Jose Business Journal. I did not realize that this article was reposted online in Advance and just came across your comments to the quotation from the article. I absolutely agree with your concerns regarding the statement "bottom of the barrel." I never used that phrase in my over-the-phone interview with the journalist. Unfortunately, the journalist was under a tight deadline and needed to publish the article the same day, disallowing me the opportunity to review the accuracy of my statement in advance of publication. Unfortunatley, I have also learned that "creative paraphrasing" happens quite frequently in journalism, and I will be more keenly aware of how my statements are published in the future.

Back in February 2010, we were gravely concerned about the proposed reduction in reimbursement for occupational therapy services by Anthem Blue Cross and the limited access our clients would have to a large viable network of OT practitioners here in California. My comment to the journalist was that there may be practitioners who would accept the reduced rate that was proposed by Anthem Blue Cross, and unfortunatley this statement was then paraphrased incorrectly in the published article.

I have tremendous respect for the occupational therapy profession and the OT practitioners who serve our clientele with excellence! My deepest apologies for any misrepresentation this article or the published statements may have created.

Thank you for your feedback and the opportunity to clarify the statements from this reposted article. Feel free to contact me should you have any questions or concerns.


Sincerely,


Shawn Phipps, MS, OTR/L
President
Occupational Therapy Association of California
pres@otaconline.org


Shawn Phipps,  President,  Occupational Therapy Association of CaliforniaJuly 12, 2010
Los Angeles, CA



Shame on Shawn Phipps for making a very unprofessional comment about some therapists being at "the bottom of the barrel." I think Phipps owes all occupational therapists an apology.

Besides appalling this statement is a judgmental and insensitive assessment of fellow therapists. Have you ever heard a physician call any of his peers "bottom of the barrel" doctors? No, physicians respect their profession enough not to pass judgment on their peers. Unfortunately Phipps seems to lack that respect for occupational therapy.

Chris ,  OTR/LMarch 09, 2010
OH



"The bottom of the barrel - will take anything". Wow, what an insult to the therapists and the patient. I'm astounded at that statement!

maggie March 04, 2010
WA



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