AWP Filers Flood ABCBS Network

Since the Arkansas Patient Protection Act, or “any willing provider,” court decision was handed down in June, Arkansas Blue Cross and Blue Shield has received at least 391 individual provider applications in the nine-county region that includes Northwest Arkansas.

Providers in Benton and Washington counties account for most of those applications in the region, which also includes Madison, Carroll, Boone, Newton, Marion, Searcy and Baxter counties, said Mel Blackwood, regional executive with ABCBS.

Blackwood said ABCBS insures 24 percent of the market share, which is based on its nine-county estimate of about 503,000 people.

Statewide, ABCBS has received more than 1,900 new applications from providers in the last year wanting to be in its network, the majority of which have been received since the June ruling. That’s in addition to the 5,500 providers already in the ABCBS network statewide.

ABCBS began sending out forms to potential providers in August, said Max Huer, spokesperson for ABCBS.

Blackwood said the potential for applications could reach more than 3,200 statewide.

In 1995, Arkansas legislators passed the Patient Protection Act of 1995, which called for health insurance companies to pay the same benefits to any provider, such as hospitals or physicians, willing to accept the respective terms.

ABCBS’ 10-year battle against the law ended in June when the 8th U.S. Circuit Court of Appeals upheld most of its language.

Self-insured plans, such as the insurance plan of Wal-Mart Stores Inc., are excluded from AWP and can continue using a restricted network.

Jennifer LaPerre, executive director of business development for Mercy Health System, said Mercy has already signed four new contracts since August, with a fifth coming shortly.

She said Mercy really didn’t start conversations with payers until September.

She said Mercy, as both a hospital and physician provider, has seen contract opportunities. Of the contracts signed, some are with insurance companies, but other new agreements are with network providers and third-party administrators that process claims for employers.

Huer said it’s too early to tell how many providers will be added to the network. Huer said it takes at least 30 days on average to process an application that is filled out correctly.

Blackwood said there are 15 different provider types that ABCBS has never dealt with directly before, such as nurse practitioners, physical therapists and dieticians, all of which can file claims directly with ABCBS now, instead of through the physician.

The big elephant in the room, so to speak, is reimbursement.

In July, ABCBS notified physicians that it would cut reimbursement on its indemnity plan by 10 percent. But Huer said ABCBS decided not to cut rates, after “constructive feedback from the community.”

LaPerre said her organization has studied AWP laws in other states, such as Kentucky, which passed an AWP law in the mid-1990s.

LaPerre said AWP law in Kentucky caused the top two insurance carriers in the state to grow larger, and reimbursement for providers over time eventually fell.

“We are very aware that one way to reduce health care costs is to reduce reimbursement to providers, but as a provider, that’s concerning to us because that may not be the best way to control health care costs,” LaPerre said.