Matt Chaney | Capital News Service
RICHMOND – Virginia’s largest provider of primary and urgent health care, Patient First, has stopped accepting new patients insured by Anthem Blue Cross Blue Shield, citing Anthem’s “reduction in the reimbursement rates paid.”
The change, which took effect Feb. 2, also excludes all Anthem members with HealthKeepers Plus plans, even people who are existing patients at Patient First.
Ian Slinkman, the director of marketing and public relations at Patient First, said in an email, “The costs for delivering care increase year over year. Every one of the other Virginia payors with whom we contract understands this and provides reasonable trend increases that enable us to maintain our high levels of access and service.”
However, he said, “Anthem instead insists on reducing our reimbursement back to 2012 levels.”
In a separate email conversation Wednesday, Anthem’s media contact, Scott Golden, said Anthem pays Patient First the same reimbursement rates it pays other health-care providers in Virginia.
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“Patient First has indicated the current level of reimbursement from Anthem, and the lack of guaranteed annual fee increases, put Patient First in an unsustainable position,” Golden said. He said the action by Patient First violates its provider agreement with Anthem.
Patient First disputed this claim on its website by saying, “In order to provide our patients with the best care possible, we have always protected ourselves against unreasonable reimbursement practices that would prevent us from preserving the breadth and quality of our services.”
Golden and Slinkman gave different answers as to whether the two sides were in talks to find a resolution.
“We remain in discussion with Patient First and are working hard on our customers’ behalf to reach a resolution,” Golden said.
But Slinkman said that as of Tuesday afternoon, no talks were going on between the two parties. He did say that Patient First is “open to a reasonable resolution and to minimizing the effect on current and future patients.”
“Our goal is to preserve our ability to make available and provide the kind of safe, convenient, and cost-effective care our patients have experienced and come to expect,” Slinkman said.
Patient First’s new policy will affect two categories of Anthem members:
- New patients, who have never been to Patient First previously, who are members of Anthem, HealthKeepers and any BlueCross BlueShield plans, excluding CareFirst BCBS.
- Any patients enrolled in Anthem’s Medicaid/FAMIS program, HealthKeepers Plus.
Here is some other managed Medicaid plans in which Patient First participates. The full list is at https://www.patientfirst.com/InsuranceParticipation2/VirginiaInsuranceParticipation.aspx
- Coventry Cares of Virginia
- InTotal Health
- Virginia Premier
- Optima Family Care
For help finding primary or urgent care alternatives within their current Anthem plan, Golden suggested that members visit www.anthem.com or call the customer service number on the back of their Anthem identification cards.