Anthem Blue Cross Blue Shield Kicks Cleveland Clinic Out of Network

Anthem Blue Cross Blue Shield Kicks Cleveland Clinic Out of Network

October 01, 2013

(The Biggest Obamacare Side Effect in Ohio)

A couple weeks ago I attended a mandatory, in person training for Anthem Blue Cross Blue Shield at their office in Youngstown, Ohio. The purpose of this training was to teach their independent agents the ins and outs of their new health insurance plans and make sure we understood the scope of all their changes.

Boy there were some big ones.

It seems like forever, but I have been saying things like "it's going to get crazy" or "it's going to be nutty" half joking, half serious. Mostly I was trying to convey the fact you would be buying your health insurance in a completely new way starting today. Those differences, mainly created by Ohio's Health Insurance Marketplace, where what was going to create the "craziness."

However, I completely underestimated how far these changes would go, to the point Anthem would, in a sense, throw away one of their biggest competitive advantages.

[NOTE: I was required by Anthem to sit on this information after the meeting, they had not yet gone public with it and requested brokers not say anything]

What Was Anthem's Biggest Competitive Advantage?

If you are buying an individual health insurance plan inside or out of the Marketplace from Anthem, you will no longer be purchasing a plan with access to their "Blue Card" which provided you the ability to easily access their network across state lines and throughout the country.

The size and ease of network usage was one of the biggest advantages Anthem had over other health insurance companies in Ohio. You had the ability to receive treatment from more doctors and hospitals at in-network pricing than any other company.

The plans you apply for starting October 1st, that take effect January 1, 2014, can no longer make that claim.

One of the biggest shockers of this "network shake up," as I'm calling it, is that Anthem decided to hitch it's post healthcare reform wagon to University Hospital system in northeast Ohio and exclude The Cleveland Clinic, the largest hospital system in the state, from it's network.

Let that sink in for a second.

I'll repeat that one more time. The Cleveland Clinic is no longer in Anthem's primary network of hospitals under the Affordable Care Act.

Statewide Network Epidemic

This isn't just going to effect Northeast Ohio, this is happening across the entire state.

Here's a list of the hospital systems Anthem has choses in other cities:

  • Mt. Carmel - Columbus, OH
  • Kettering - Dayton, OH
  • Trihealth - Cincinnati OH

That means if you currently receive treatment from any of the other major hospital systems in those cities, you are going to want to do some rescheduling or hold on to your current Anthem plan for dear life.

I have been advised that Anthem's updated provider locator tool is not updated to reflect these changes yet, so you won't be able to search for new doctors just yet.

NOTE: This has NO IMPACT on your current Anthem personal policy or existing coverage through work. These network changes are only for NEW individual plans sold inside or out of Ohio's Health Insurance Marketplace starting today October 1, 2013 with a January 1, 2014 effective date.

Why Anthem, Why?

The next logical question crossing your mind is "why is this happening?"

That's a great question.

There are several theories floating around, the biggest being related to keeping costs down. When an insurance company includes a doctor or hospital in its network, that means those providers have agreed to see you (a person with health coverage from Anthem) for the discounted price they negotiated.

If Anthem can't negotiate a low enough price for those services that means the overall cost of their health insurance policies will have to go up to cover them.

To a lesser extent, it could be that both parties are failing to realize just how important and possibly dependent they are on each other.

If I know you at all, this is a big enough deal where you would gladly pay a decent amount more to be able to see the the doctors you want.

What Should You Do Then?

That's a pretty loaded question.

It's going to be hard to say without knowing your specific situation, however if you are comfortable receiving treatment for the remaining hospital network in your city, then Anthem will still remain a solid choice for you.

Just know, that you could find yourself in a situation three to four years from now where you might get referred to an out of network doctor and have to choose between seeing the best recommend doctor and paying more, or finding an alternative that's in network.

If this entire topic rubs you the wrong way, chances are you will want to consider a company that is not making any major changes to their network and will offer a variety of choices in your city.

The Bottom Line

This is the biggest side effect of the Affordable Care Act I didn't see coming. This is going to create more problems than a government shutdown if/when you or anyone else tries to buy their health insurance on their own without any assistance from a licensed professional.

Of course, there are those in the state and country who getting access to any doctor is an improvement, however for those of you who are more specific about your medical treatment, this will be one of the biggest deciding factors.

When you start to consider your new Affordable Care Act options, make sure the network is one of the first questions you ask about. Just knowing there is a huge difference between networks moving forward gives you a serious advantage for your first trip to Ohio's Health Insurance Marketplace.

You Tell Me

I have to know, what do you think about this? Will you pay more for the ability to see the doctors you want?