Small Business Benefit Solutions Blog

Archive for the ‘Anthem Blue Cross’ Category

Walgreens Pharmacies has elected to stop participating with Express Scripts, the pharmacy benefits manager of Wellpoint Blue Cross plans at the end of the year.

Walgreens and it’s affiliated pharmacies, including Duane Reade Pharmacy in the New York City metro region, Happy Harry’s Pharmacy in several northeastern states and OptionCare, will stop processing Anthem and Empire Blue Cross member prescriptions on an in-network bases effective on January 1st, 2012. 

Access to other retail pharmacies within the pharmacy provider network will be available, as the Express Scripts pharmacy network contains more than 56,000 pharmacies without Walgreens.  On average, there is another network participating pharmacy within one-half mile of any Walgreens pharmacy.

You can find other participating pharmacies in your area at www.anthem.com or www.empireblue.com and then you can search by pharmacy name or by your geographic location.

If you are unsure whether your small business health plan or your individual medical insurance plan will be effected by this change, contact your carrier, your agent, or call Small Business Benefit Solutions, LLC and we’ll look up your pharmacy for you.

New Hampshire Individual Customers Billed Incorrectly

Due to a system error, the monthly premium shown on some January and February statements mailed to Individual members from Anthem Blue Cross and Blue Shield were incorrect.

Based on the annual premium rate noted in the member’s renewal letter, the amount due number shown was less than it should have been.

Anthem says they have made the necessary correections and have sent a letter to the effected members directly.

If you’re unsure what to do with your bill, follow these steps:

• If you have already paid your premiums for January and February, you will receive a new bill that shows credit for your payments made and the balance due.
• If you have NOT paid your January and February premiums, you should wait until you get a new bill with the corrected amount.
• If you use our Electronic Funds Transfer system to pay your bill, the next withdrawal will include the remaining balance due for January and the correct February premium.
• If you received a late notice because of a missing or partial January payment, you should disregard it. Their grace period will begin with their February bill.

If you have any questions, please contact Small Business Benefit Solutions, LLC, your broker or agent or you can contact Anthem directly at the phone number on the back of your ID card.

Anthem Blue Cross has added several procedures that will require pre-approval before benefits get paid.

Effective with group insurance plans that renew in March this year, Anthem Blue Cross and Blue Shield of NH has announced that it will scrutinize the following medical services:

• Air Ambulance Travel
• Diagnostic Testing
• Certain Ambulatory Surgical Procedures
• Other Outpatient treatments that remain unspecified

Anthem claims this policy change is in an effort to provide “you and your employees access to the best health care at the best value.”

The carrier is claiming that the pre-authorization process will help determine medical necessity of certain outpatient care.  They are assuming that the physician, who spent at least 8 years in medical school, is incapable of making this determination, a slap in the face to all doctors who rail against the pre-certification process as an effort by insurance companies to undermine their education and experience with bureaucratic red tape.

Anthem has not specified exactly which diagnostic exams or which ambulatory procedures are going to require pre-approval.  It’s safest to operate under the assumption that all procedures will require pre-approval.  Anthem gave out a phone number for members to call in case you want to know if the service your doctor recommends requires this pre-approval.  The number is 866-672-3666, but when we called this number there was no option for determining pre-approval so SBBS cannot be sure that this resource will be helpful.

Your Anthem participating doctors will be getting similar correspondence which will tell them more specifically, what procedures they will have to get pre-approved.  If you do not use Anthem participating doctors, it will be your responsibility to get this pre-approval.

Anthem claims that their decisions will be based upon “standards of appropriate care drawn from medical policies, clinical guidelines and the terms of your plan”, but whether it will be a medical expert making these decisions, or a kid in front of a computer screen, is yet to be determined.

Either way, expect that you will have a lot more hoops to jump through if your doctor wants more than just a standard office visit.

While other carriers have not announced such stringent pre-approval notices, this may be the newest wave of inconvenience to hit the health insurance policy-holder thanks to the upheaval of health care reform.

If you are dissatisfied with Anthem’s decision and currently hold and Anthem Small Group insurance policy, please contact Small Business Benefit Solutions, LLC and we can explore carrier alternatives for you.

Anthem Blue Cross and Blue Shield has announced that the Bank of New York Mellon will replace ARCUS Bank for all High Deductible Health Plan members who are using Anthem to manage their Health Savings account bank accounts.

(This announcement will only effect clients of SBBS located in NH.)

Anthem Blue Cross and Blue Shield has decided to stop offering the ARCUS Bank health savings account (HSA) product. As a result, ARCUS is transferring clients’ Health Savings Accounts (HSA) with ARCUS to a The Bank of New York Mellon (BNY Mellon), as of July 01, 2010.

ARCUS and BNY Mellon will handle all of the details of this transfer.  You do not need to take any action yourself.  Accounts will be opened subject to the Terms and Conditions Statement of Mellon Bank and they will be contacted if additional information is needed.

Please be assured that you funds are safe and will continue to be insured by the FDIC up to the amounts allowed by law.

We expect there to be many questions about this transfer of your account to BNY Mellon, so we have included with this letter a comprehensive set of “frequently asked questions,” as well as a rate and fee schedule.  BNY Mellon will be sending additional details in the mail over the next few weeks to affected clients.

If you do not wish for your account to be transferred to BNY Mellon, you can contact ARCUS at 1-877-373-9859 no later than June 28, 2010, to receive additional assistance.

As always, you are free to select your own lending institution to manage your Health Savings Account.