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Important Information on the Anthem Exchange Addendum

As you may have seen in CMA's April 7 Alert, Anthem Blue Cross sent an addendum to over 11,000 practices who are participating in their individual / exchange network. The addendum makes changes to a prior addendum sent out in 2012. CMA has concerns with a few provisions, outlined in the Alert article.

While CMA's article identifies issues with three provisions in the addendum, of significant concern is the language in section 12, which removes a participating physician’s ability to opt out of the individual / exchange product without affecting the underlying Prudent Buyer contract. Effective July 1, 2014, the only option for physicians who wish to opt out of the individual / exchange product is to terminate the underlying Prudent Buyer PPO agreement.

The addendum only applies to physicians who are currently participating in the Anthem individual / exchange product; however, CMA is concerned that many physicians still don’t seem to know that they are participating in this network. Additionally, CMA is concerned with the lack of transparency in the text of this provision. Many practices will simply not understand the intent of the language or the impact on their practice.

CMA will continue to re-run variations of its April 7 Alert article between now and July 1 to ensure that affected practices are aware of the changes and how they may impact their practice.

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