2016 Exchange Plan Changes

 In Articles, Coding & Documentation

In an effort to control costs, insurers have presented an increasing number of narrow network plans for purchase on the exchanges. While these plans tend to have lower premiums for members, they continue to blur the line regarding which providers are in or out of network. The member choosing such a plan would ideally know that his or her preferred providers are in network prior to purchasing the plan, but that is not always the case. Therefore, the burden of eligibility screening and verifying benefits status is ever increasing on the part of medical practices and providers … if they enjoy being paid for services rendered.

As an example of the complexity of the current state, Blue Cross and Blue Shield of North Carolina (BCBSNC) added a new narrow network, Blue Local, for the Triangle area. In 2016, there are now 5 different BCBS plans offered to NC residents. Let’s say you live in Alamance County – your only option is a Blue Value plan. If you live in neighboring Guilford County, you can purchase a Blue Advantage or Blue Select plan. If you live East of Alamance County in Orange County, your options are Blue Value and the new Blue Local plan. And to add one more layer to the puzzle, providers may be in network with none, some, or all of these plans.

We should continue to expect changes as the narrowing of networks has the attention of Centers for Medicare & Medicaid Services (CMS). CMS has proposed creating minimum standards for plans sold in the marketplace in 2017 to address the shift toward narrowed networks (Modern Healthcare). Until then, be diligent in reviewing provider directories and updating your own websites to reflect the payors and plans you participate with. Transparency is key.

Learn more: Modern Healthcare

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