New policy from Anthem of MO heavily impacts lab payments

February 12, 2019

Anthem updated their MO professional rate schedules, effective Nov. 1, 2018, for the following products:

  • Blue Access
  • Blue Access Choice
  • Blue Preferred
  • Pathway
  • Pathway X
  • Anthem Alliance

Alarmingly, these new rates reflect a more than 70 percent reduction from previously negotiated rates for many groups, which is significantly below 2019 Medicare rates published in the Medicare Physician Fee Schedule and Clinical Laboratory Fee Schedule.

When we inquired with Anthem representatives about this drastic policy shift, we received the following response:

Anthem members should experience the same out of pocket costs regardless of site of service. Anthem updated their professional fee schedules to align compensation for lab rates in all settings. This change helps drive a consistent out-of-pocket cost experience based on services rendered.

Needless to say, this change is unprecedented for hospital-based labs.

However, as we have recently experienced with Anthem’s policies on ER visits and MRIs, Anthem is making moves to drastically cut reimbursements to ancillary providers. It appears they’ve now turned their attention to making similar changes for pathology services.

Despite this significant policy shift, our intention is for this letter to raise awareness of an issue we feel is currently being underdiscussed. Many pathology groups we’ve spoken with either were not aware of these cuts, or only just recently began to realize their full impact. We’ve projected some groups we work with within the state could lose roughly 50 percent of their annual revenue from Anthem due to these reductions.

That’s why we’re asking you to help create awareness of this issue before it’s too late. With enough vocal and written opposition, we can hopefully leverage our positions as stakeholders to help Anthem understand how unprecedented and misguided this policy truly is.

Please reach out to us directly at 517-486-4262 for more information or to discuss this issue further.

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