Thursday, September 26, 2013

Anthem, Health coop, HPN Networks and exchanges

Anthem had their exchange broker roadshow yesterday and announced their brand new plans coming for 2014. The big differences? The drug formularies and doctor networks.
This has been a big concern for health insurance companies in deciding how to take on the increased medical risk and still keep insurance costs down. The best way to do it was to decrease the amount of contracts they issue to doctors and hospitals and change the medications they cover on the plans. They are gearing up to focus more on a patient-centered model where they require more referrals and a concentration of care centered around a general practice doctor.
If you wish to participate on the Nevada Exchange and purchase a plan that includes some advanced premium tax credits,  expect to also receive a smaller choice of providers. Be sure to check with the plan's networks and know if that doctor you like will even be participating. Chances are your doctor won't know, so check with the provider directory. Just because they say they accept or are contracted with Anthem, Health Plan of Nevada, etc, doesn't mean they are contracted with your plan. Also, just because your drug was covered with that carrier on another plan, doesn't mean that drug will be covered on your plan either.

This is why it is so important for people to talk with a professional. They can make sure and verify everything and actually guide you according to the plans you actually need.

2 comments:

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