- At least four pediatric specialists in the Austin, Texas, area have notified patients they intend to stop accepting children covered by Blue Cross and Blue Shield of Texas Medicaid plans, citing failure to pay providers for certain services, the Austin American-Statesman reports.
- Central Texas Pediatric Orthopedics, the only Austin-area orthopedic specialist accepting Medicaid, was one of those preparing to drop the plans, but has reportedly reached a preliminary agreement with Blue Cross and Blue Shield to remain.
- A neurology practice and urology practice have also reportedly resolved issues with the insurer. But Corridor Pediatrics declined to renew its contract and will stop accepting most Blue Cross and Blue Shield Medicaid plans at the end of this year.
The situation in Texas echoes a larger ongoing fight between payers and providers over what procedures and settings offer the best combination of cost and care quality.
Anthem, which runs Blues plans, has particularly irked providers over the past year with policies that restrict coverage, including no longer paying for MRIs and CT scans performed at hospitals on an outpatient basis and limiting the use of anesthesiologists during cataract surgery.
Many payers are watching the Anthem moves, though few have been as aggressive.
If payers end up driving providers away with such restrictions, they risk furthering an existing problem for managed care plans by reducing the number of covered providers available.
Narrower networks are one way payers can try to keep their premium rates down, but providers and regulators say some insurers go too far and make their networks excessively restrictive. As managed care plans in Medicaid become more prevalent, this could become an even bigger issue, with rural patients at particular risk of losing access if providers stop accepting plans.
In a recent review of Medicaid managed care plans in 14 states, those with narrow networks had 3% higher physician turnover after one year and 20% higher turnover after five, compared with non-narrow network plans.
According to the Health Affairs report, 80% of Medicaid beneficiaries are in managed care plans, many with complicated medical needs. Interruptions in care, like losing a primary care doctor, can impact patients’ health, but that the effect “might not be detected by existing measures that evaluate network breadth,” the authors said.
Washington State fined Centene’s Coordinated Care unit $1.5 million in December over deficiencies in its provider network, then tacked on an additional $100,000 when the insurer didn't adhere to an agreed-upon compliance plan to fix it.