Big Blues Begin Pull Out from the Affordable Care Act

October 8, 2016

Blue Cross Blue Shield is jumping ship, here's what you need to know, and how it might affect your practice.

I just read an article in the Investor's Business Daily regarding several Blue Cross Blue Shield plans that are exiting the healthcare exchanges created by the Affordable Care Act. I believe this will end up being the nail in the coffin for the exchange plans. Especially coming on the heels of Aetna and Humana pulling out of the market, and United HealthCare's exit earlier this year. Seems like the house of cards is tumbling down.

What does this mean for you and your practice? Here are a few things to consider:

• If you signed up for a reduced reimbursement rate with these plans, you will no longer have to see these patients. Be sure that when Blue Cross Blue Shield approaches you (and they have to) that whatever contract you have with them is ended for those plans. They're sneaky and I wouldn't put it past them to try to hide the exchange plan contract amid your current PPO plans, or make an attempt at merging them "for your convenience." Read the fine print.

• Your patients who were forced to sign up for health insurance or pay a federal fine will be dropped from these plans. They will be freaking out and most likely ask your advice as to where to go from here. You cannot legally tell them to go with "Plan X." You can, however, lay out insurance plans you do take and encourage patients to do their own research. A spreadsheet listing potential options is a great start. Patients should be able to compare plans that include the healthcare options they are looking for. If they panic or just don't want to deal with it and go to an insurance broker, they need to make sure they understand fully what they are purchasing. Back when these plans first started, even the brokers were not informed of what a "mirrored plan" was. We had to figure out the payment trends and learn about them firsthand. Then, we educated our patients and the brokers. Neither was happy about being misled.

• Understand that the possible fall and dysfunction of the ACA means that insurance plans are all in a flux right now. Now that the "Blues" are pulling out, others will follow, to be sure. This means you need to read up on as many articles that you can. Keep yourself informed, read any and all correspondence coming from every insurance company that you accept at your practice. Know what plans you were taking under the exchanges.

• Know that there are state and federal agencies that will hopefully intervene, and make transitions better than they have been in the past. The Department of Managed Care here in California has an outstanding staff, and they hold insurance companies over the fire if they cross a line and break the law. So, fingers crossed they are keeping their eyes on this!

The most important thing for you to do is educate yourself as much as possible. This isn't going away, and it's going to get a lot worse before it's going to get better. Protect your practice with knowledge and perseverance. Understand your contracts. Get copies of them from provider services, if you don't have them readily available. Be sure your billing staff (in-house or third-party) is also educated and informed. They will need to know how to respond to patients when they call, and they will call.