At a hastily arranged conference call for insurance agents to address a variety of issues involving new individual and family health plans for California, the Anthem Blue Cross Regional Sales Manager for Northern California announced they were extending the payment deadline until January 31st for policies sold through Covered California with effective dates of January 1st, 2014. This is the third time Anthem has extended the deadline for new enrollments.
Covered California chaos hinders Blue Cross billing
In addition to the chaos created by Covered California regarding the transfer of new enrollment to Anthem Blue Cross, they are also juggling numerous internal and external issues to meet demand. The call volume has been three times what Anthem Blue Cross anticipated from open enrollment in new California health plans by individuals and families. No doubt, a good chunk of the calls revolve around paying the first month’s premium and for which many new members have yet to receive. Covered California has been very good at sending scar-e-mails to pay the invoices, but they come up short on providing help to actually get an invoice.
Application Control Number crucial
Anthem Blue Cross recognizes that no member can pay online, on the phone or send in a check without knowing the Application Control Number sent out on the invoice. They are dealing an unexpectedly high volume of new enrollments as well as missing or incorrect data from Covered California. The Regional Sales Manager said they had pulled in resources from other states and hiring third party administrators and temporary staff to clear out the back log of invoices that have not been mailed. Another snag that was revealed was that Anthem had been sending invoices to the physical address and not the mailing address of new members.
Covered California Anthem payment link is bad
From a client who tripped across the error and solution
PROBLEM: As I told you yesterday, when I went to the Covered CA website, logged in and went to the Enrollment Summary page, I saw a Carrier Website address link for Blue Cross Anthem that was supposed to take you to the payment site. The link is: https://shop.anthem.com/sales/
SOLUTION: Today I figured out that the problem is that the Covered CA website link (https://shop.anthem.com/
Payment deadline push out to January 31st
In light of the severe delays of generating invoices for new members, and realizing the January 15th deadline was fast approaching, Anthem Blue Cross decided it would be the prudent move to extend the deadline until the 31st. If nothing else, the deadline extension might take some of the pressure off the call center. My calls to Anthem were dropped twice this morning, once after 45 minutes and again after 1 hour and 15 minutes. Fortunately, I was able to connect to the conference call.
A few other updates were provided as well
- Pathway is the name of the new network of providers for individual and family plans offered on and off the exchange.
- The network is the same for all California individual and family plans.
- Unlike other providers, Blue Cross does not have a separate PPO and EPO network.
- An Exclusive Provider Organization (EPO) member can see any doctor in the statewide Preferred Provider Organization (PPO) network.
- Similar to an HMO plan, EPO plans will have no coverage for out-of-network providers such as doctors or hospitals.
- EPO networks will have Tiered Facilities (Tier 1 and Tier 2). The Tier 2 facilities are not showing up in literature or online and Anthem is working to correct that.
- Tier 1 facilities will have a better coinsurance percentage such as 20% member responsibility – 80% Blue Cross responsibility after any applicable deductible.
- Tier 2 facilities will have a 50%/50% split responsibility. This is to drive more use of Tier 1 facilities.
- There will be no Sutter Doctors available to members in Northern California individual and family plans either on or off exchange. Some Sutter facilities may show as “in-network” on the Doctor Finder search tool, but the doctors will not be in-network.
- There seems to be real confusion regarding the handling of old health plan automatic bank drafts or EFTs (electronic funds transfer) and new plans. Families that were policy holders in 2013, then enrolled in a new plan either off-exchange or through Covered California, are still being debited for their old plans. Again, the Sales Manager encouraged us agents on the line; Anthem is aware of the problem and is working to resolve it.
- Anthem Blue Cross will not honor the “Blue Card” program for individual and family plans. The Blue Card program allows members to use providers out of state Blue Cross – Blue Shield network for routine office visits (perhaps on extended vacation or sabbatical) and pay the respective copayment or coinsurance charge of the provider. Only emergency care will be covered when travelling outside of Californian. Blue Shield will continue to honor the Blue Card program for their California individual and family plans.
Official Anthem Blue Cross official deadline extension announcement
Payment deadline extended to January 31 for individual plans purchased on or off exchange
January 14, 2014
Consumers who purchased an individual health plan with a January 1 effective date now have until January 31 to submit payment for their first month’s premium. This extension applies to individual plans bought on or off the exchange. And coverage will still be effective on January 1, as long as the application was received by the December 23, 2013 deadline.
Initial payments must be received (not postmarked) by January 31. If your clients haven’t already mailed payment, encourage them to make payment online via the payment portal. In order for your client to make their payment online, they will be required to enter an Application ID which can be found on the payment letter.
If payment is received after January 31, on-exchange clients must go back to the exchange and request a new effective date. We cannot automatically change the effective date for them. Payment deadline is January 28th for on-exchange clients seeking a February 1 effective date.
On-exchange clients can make their initial payments on our payment portal. For off-exchange clients buying online, the initial payment is a built-in feature of the online application process.
For existing clients transitioning to new plans or renewing, the payment deadline is January 31. For existing transitioning clients, payment can be made via WebPay on the Anthem Member Portal. They will need to link the summary bill into their WebPay account as explained here. The summary account bill number will be at the top of their bill.
Due to many questions about health care reform, such as this one, our service centers are experiencing a high volume of calls. Please rest assured that we are working hard to reduce wait times and handle all calls as efficiently as possible. We appreciate your patience and your continued support.