Anthem Blue Cross of California announced that they are shipping new and improved membership cards for individuals and families in the Exclusive Provider Organization (EPO) health plans in California. The new cards will have the very important three little letters of EPO actually imprinted on the card.
New Blue Cross member cards with EPO
Gone is the misleading PPO designation on the EPO member card.
The previous member EPO member cards read “Pathway X Tiered” with PPO written on a suitcase. While this twisted designation made sense to the marketing guru at Anthem, most people thought it meant they had to carry their luggage to lower X level tier of the hospital. In reality, the “Tiered” designation does mean that the member was in a tiered network. Tier 1 hospitals would charge the member less for procedures than tier 2 hospitals. Unfortunately, no one really knows which hospitals and other providers are tier 1 or tier 2 from the provider search website.
Doctors and members confused over Pathway X Tiered PPO
The biggest problem with the Tiered PPO designation on the cards was that an EPO isn’t a PPO (See: What is the difference between a PPO, EPO and HMO). Doctor offices had been accepting the Tiered PPO card as if the member was in a PPO. Out of network doctors were billing Anthem Blue
When is a PPO not a PPO? When it’s a Pathway X Tiered PPO B.
Cross only to have their claims denied. Exclusive Provider Organizations have no “out-of-network” coverage like the PPOs. In February a pregnant client’s OBGYN told her they just realized the Tiered PPO was an EPO and they were out-of-network with Anthem Blue Cross for individual and family plans. She either had to find another doctor to deliver the baby or pay full price for all the office visits and services. Thank you marketing guru at Anthem Blue Cross.
New EPO cards in the mail by May
Anthem Blue Cross hopes to have all cards mailed by the end of May. The update to agents included the following information.
Having this additional information on their ID card will make it easier for the member when someone asks what type of plan or network they have.
We will mail the revised cards to these members starting on May 13th. We expect to have all cards in the mail by May 19th.
The cards will arrive with a message that explains why they’re being replaced. The message will also tell members to discard their old card and start using the new one right away.
The new cards will only be issued to members of EPO plans in California.