Understanding Anthem Blue Cross CA 2014 Plans & Networks

Anthem has not yet rolled out all of the plans/networks/information for 2014 ACA plans but I want to update what we will all be seeing in the near future as choices for health insurance enrollment with Anthem Blue Cross.  


Some areas will not have a PPO option like LA county/Orange county and will have an EPO and HMO option.  Other areas will have a PPO option.  The Anthem program for 2014 will break down like this:

Networks:

The ACA networks for Anthem individual plans will be called "PATHWAY" and all participating providers will need to be contracted with the appropriate Pathway network.

Pathway PPO
Pathway HMO
Pathway Tiered (EPO)

Provider searches (once available online) will show two versions of Pathway for searching, Pathway and Pathway-X.  Pathway indicates off-exchange and Pathway-X indicates on-exchange.

EPO will be a tiered network with lower costs for inpatient & outpatient services in tier 1.

Plan names will reflect if plan is on-exchange or off-exchange as follows:

On-Exchange: Bronze, Silver, Gold, Platinum
Off-Exchange: Core, Essential, Preferred, Premier

Anthem will offer a total of 26 health plans across California (not all in all regions).  These will include:

On Exchange and "Mirrors" Off-Exchange
Bronze - 4
Silver - 3
Gold - 3
Platinum - 3
Catastrophic - 1

Off Exchange Only not Mirrored
Core (Bronze) - 8
Essential (Silver) - 4
Preferred (Gold) - 0
Premier (Platinum) - 0
Cat - 0

PPO and EPO Plans will be referred to as "Direct Access" and HMO will be "Guided Access".



Dave
www.davefluker.com

Comments

  1. This is great information and the ONLY place that has it. I've been looking all over the internet for details like this so a big thumbs up from me. Now, any info on Blue Shield and why my Alameda County (Region 6) seems to be stuck with an EPO that has very little in it? Tragic for me since I live in Pleasanton and the Valleycare Health System doesn't seem to be represented at all, even though I live next door to Valleycare Hospital and all my doctors are located there.

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  2. I live in Pleasanton too and very much appreciate the information provided here. I can now see why I haven't been able to get info from Anthem Blue Cross about which providers are on their plans - they haven't figured it out yet! (But they are ready to charge me $782. for the privledge of not knowing what I'm purchasing.) From what I can tell, the Blue Shield "off-exchange" policies only offer the same doctors and hospitals as their "exchange" policies and that list is very limiting. Anthem Blue Cross "hints" at (but won't confirm) that their off-exchange PPO has a wider network of providers - but thy're not being specific. From what I can tell, Anthem Blue Cross has John Muir in their PPO plan and I would much rather go there than Valley Care.
    I'm happy about the ACA but once again these insurance companies are screwing us over any way they can.
    Anyway, thank you Dave Flucker for confirming that the info is not available yet. I will wait it out for now.

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  3. Thanks. Anthem sent me this huge 729-page list--supposedly to show me who is on the off-exchange HSA-compatible plan for LA County. I'm totally confused because the header says "Pathway X - Tiered Pathway Tiered - ON OFF Individual Exchange EPO Tiered Network." I can find my doctors and hospital on here, but I'm concerned that the column "Tier" might be indicative of whether or not my doctor is in the 2014 plan network (rather than his name just being on this enormous list--which might include all doctors). The list is at http://www.anthem.com/shared/noapplication/f0/s0/t0/pw_e207228.pdf?refer=popcontent&refer=popcontent

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    Replies
    1. I am also confused about this list. Is every doctor on the list on all the Anthem plans in the health exchange? What are the tiers?

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  4. Could you please explain what the Tiers are. I'm looking at the Anthem Silver EPO plan. I see that there are two tiers. What does that mean? What determines which tier a service or physician is on ? I'm utterly confused.

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  5. As of Jan.2 I have one letter from Anthem, in December, asking for payment. I have no member ID card, no policy, no policy number, and have been unsuccessful in finding more than cursory description online. The above re tiers confuses me as well as others. There is no list of providers within network that I can find or know of. I contend that Anthem breaches its policy by its multiple failures, and its obligation of good faith and fair dealing. I would consider launching a class action lawsuit to recover back the cost of supposed but ineffective coverage for the duration. Attorneys interested? steveinsf @ outlook.com

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  6. I have signed up for the Platinum 90 EPO because I was told that UCLA and it's staff specifically took this plan. Is EPO the same as PPO?

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  7. January 10,2014
    Same as above. No card. Three payments sent none processed? Whats up?

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  8. Anthem is just starting to send out member cards this past week, even though they haven't processed the first premium payment yet. But on the Anthem website's doctor and facility search it finds ZERO hospitals within 100 miles as supporting the new plans, and only a handful of doctors nearby but many of those listed appear to not be accepting new patients.

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  9. I have had coverage since I-I-14, however my claims ar eith denied or the dr and pharmacy shows uneliible and I have to pay cash!
    On the phone 12 times yesterday to reach member services but too busy and will not let me even hold, Anthem hangs up! So frustrating!!!

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  10. Have Premier Direct Access but BX denies pharmaceutical coverage on a tier 2 formulary drug (their formulary) at $15 co-pay and insists I pay 10% coinsurance. Customer Service can not help as they do not answer the phone. Anyone else have this problem?

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