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Did You Hear About the BCBS Expansion?

Time for an Update

Last week Florida Blue announced its expansion of American Specialty Health Group, Inc. (ASH) network management for its Preferred Patient Care and Traditional (PPS) networks. Per Florida Blue’s notice, “This includes those in the Federal Employee Program® and members of other Blue Cross and/or Blue Shield plans accessing through Blue Card®.” This has caused a number of member calls from those concerned about the expansion.


The FCA is prohibited by federal antitrust laws from giving advice to members on whether or not to join any network or participate in any insurance plan or from influencing private business decisions in any way. As in the past, however, we do encourage you to carefully analyze the impact of ANY potential contract on your business. Each provider must determine for themselves if they can abide by the terms of a contract. Be sure that you know the terms and what you would be agreeing to BEFORE you enter into ANY contract. Get the details so that you fully understand the impact on your practice and can make business decisions that work for your practice. When in doubt, engage a health care attorney to help with your individual decision. Some of the questions you may want to ask are:

  • Is the reimbursement schedule the same as with the commercial Florida Blue plans?
  • How much reduction will this mean to my business and to overall collections?
  • Is the Tier program in effect for the Federal employees?
  • If so, do I keep the same Tier as I currently have?
  • Will the same paperwork requirements apply as with the commercial Florida Blue plans?
  • What plans are exempt from this expansion?
  • Does the same Provider Agreement apply? In other words, is this just an addition (Addendum) to my existing Provider Agreement?
Should you decide to accept a contract or participate in a network, you will be bound by its terms in the Provider Agreement. Should you choose not to participate or to leave a network, be prepared to explain your reasons to your patients and to follow the termination provision in your Provider Agreement. If a patient is unhappy with the availability of care, they can discuss this with their insurer or employer through channels available to them or they can file a complaint with the Florida Insurance Commissioner. Helpful information is posted on the FCA website.

 

 

Florida Blue Announces ASH Expansion