On October 1, 2014, Blue Shield of California notified participating physicians that it was making changes to its Individual and Family Plan (IFP) EPO and PPO products, which are its exchange/mirror products. According to Blue Shield, the changes aim to expand access for EPO enrollees and reduce confusion by simplifying its plan names.
Effective January 1, 2015, Blue Shield exchange/mirror EPO patients will have access to additional providers who are located outside of their county of residence. Previously, the Blue Shield IFP EPO limited in-network services to providers within the patient’s county of residence. According to the notice, Blue Shield is making this change to provide greater access to care and reduce out-of-network costs for enrollees. Patients and referring physicians will be able to find these additional providers by searching the Blue Shield provider directory on its website under “Find a Provider.” PPO physicians in affected counties were notified that they will be listed as in-network for EPO patients and that they will be paid at their current PPO rates.
Additionally, Blue Shield announced changes to its exchange/mirror plan names. Effective January 1, 2015, its exchange/mirror products will use the same plan/product naming conventions. Product names will also include the metal tier of the product:
|2015 PPO Plan Names||EPO Plan Names|
|Platinum 90 PPO||Platinum 90 EPO|
|Platinum 90 PPO AI*-AN||Platinum 90 EPO AI-AN|
|Gold 80 PPO||Gold 80 EPO|
|Gold 80 PPO AI-AN||Gold 80 EPO AI-AN|
|Silver 70 PPO||Silver 70 EPO|
|Silver 70 PPO AI-AN||Silver 70 EPO AI-AN|
|Silver 94 PPO||Silver 94 EPO|
|Silver 87 PPO||Silver 87 EPO|
|Silver 73 PPO||Silver 73 EPO|
|Bronze 60 PPO||Bronze 60 EPO|
|Bronze 60 HSA PPO||Bronze 60 HSA EPO|
|Bronze 60 HSA PPO AI-AN||Bronze 60 HSA EPO AI-AN|
|Minimum Coverage PPO||Minimum Coverage EPO|
|$0 Cost Share PPO AI-AN||$0 Cost Share EPO AI-AN|
*AI designates an American Indian plan
The new plan names will be reflected on patient ID cards to help practices easily identify patients with exchange or mirror products. Blue Shield has confirmed that all of its exchange/mirror product enrollees will receive new ID cards reflecting the new plan names.
Practices with questions about the changes should contact Blue Shield Provider Information and Enrollment at (800) 258-3091.