Renown Health And Anthem Blue Cross And Blue Shield Partner To Extend Value
- Print page
Anthem Blue Cross and Blue Shield Medicaid members will now have access to providers in the value-based Western Clinical Alliance, powered by Renown Health.
RENO, Nev. Members of Anthem Blue Cross and Blue Shield Medicaid in Nevada can now receive care from providers in the Western Clinical Alliance, powered by Renown Health. A first of its kind agreement, the partnership between Anthem Blue Cross and Blue Shield Medicaid and Renown Health extends care for Anthem members in northern Nevada. This agreement gives providers and patients in the region better access to care by focusing on health and well-being while reducing the overall cost of care. The Western Clinical Alliance is a value-based clinically integrated network that puts the patient at the center of care and allows collaboration between providers across the community.
Western Clinical Alliance providers including those at Renown hospitals, Renown medical groups and other community-based health organizations have developed a relationship that makes vital data and insights readily available to better understand every patients journey through the healthcare system. Providers in the Western Clinical Alliance work together to drive better outcomes by helping patients receive care in the highest-value settings.
Anthem Blue Cross Blue Shield Nevada Bariatric Surgery Insurance Coverage
Blue Cross Blue Shield is the largest health insurance company in the United States and provides a wide range of plans including Medicare, group, individual and family. Blue Cross Blue Shield also offers a number of HMO and PPO options. Each of these plans can vary drastically, despite being underwritten by the same insurance company. For example, HMO plans will require a primary care physician referral for any specialist visits, while PPO customers can choose their own doctor. Bariatric surgery coverage can vary between plans as well. Some plans cover weight loss surgery while others dont. Even plans that cover bariatric surgery may have different co-pays, and out-of-pocket expenses.
States Approach To Mcos Bolstered Insurer Participation In Exchange Albeit Only In Metropolitan Areas
The entry of Silver Summit to the exchange in 2018 was linked to the states process for approving Medicaid managed care contracts. Prior to 2017, Nevada required its Medicaid Managed Care vendors to offer at least one silver and one gold plan in the states exchange. In other words, access to Medicaid Managed Care business was not available for carriers that opted not to participate in the exchange. Anthem and United both operated Medicaid Managed Care plans in Nevada prior to 2017, and offered plans in the exchange.
For 2017, the state decided to allow four Medicaid MCOs instead of just two . And while they eliminated the requirement that Medicaid MCOs also offer QHPs in the exchange, the Nevada Division of Insurance reported that during the process of selecting MCOs, the state added five additional points to the scores of insurers that indicated on their MCO proposal that they would also offer QHPs in the exchange .
The Division of Insurance confirmed in early May that they expected all four of the states MCOs Anthem, United, Silver Summit, and Aetna to file rates and plans for 2018 QHPs that will be sold in the exchange, as a result of the information submitted during the MCO bidding process .
Nevada is considering expanding their MCO contracts to be statewide, and are also considering the possibility of reverting to their previous system of requiring MCO insurers to offer products in the exchange .
Also Check: How To Find Your Medicaid Number
Find Helpful Information With These Faqs
Here are answers to a few common questions, which may help as you start thinking about renewing your plan for 2022.
Delivering quality coverage that is truly affordable is our goal so we strive to offer highly competitive rates. Our Health Plan Advisors are also experts in uncovering more ways for you to save. Whether you need to know if you qualify for the expanded financial help from the federal government, or ensure you have the right plan for your lifestyle and budget, we’re here to help.
Your Anthem plan offers $0 preventive care§ including checkups, routine tests, and immunizations to help you and your family focus on well-being and stay as healthy as possible. You also receive prescription drug coverage, which in 2022 will include many commonly used drugs available at $0. Your plan also includes convenient 24/7 telehealth services and other virtual care benefits, so you can find care when and where you need it.
You will receive access to a leading network of trusted doctors, specialists, and hospitals along with inpatient, outpatient, and emergency coverage. Visit Anthem.com, 24/7 to search our extensive list.
Yes, you have access to 24/7 virtual doctor visits from the comfort of home through our convenient Sydney Health app.
Absolutely. We make finding a vision or dental plan that will fit your needs as simple as possible. Call 225-6272 to talk to a Health Plan Advisor and learn more.
Not intended for those eligible for Medicare.
Does Anthem Bcbs Nevada Have Pre
The short answer is yes. BCBS Nevada and all other insurance companies want to ensure that surgery is absolutely necessary before approving coverage. Therefore, they require documentation to that effect. Each plan may have different requirements, but in general, the following are guidelines stipulated by most insurance companies
Body mass index or BMI: a BMI of 35 or over with one or more comorbidities or obesity related diseases or a BMI of 40 or over regardless of comorbidity is necessary to qualify for bariatric surgery. These are guidelines set forth by the FDA. Comorbidities can include type two diabetes, high blood pressure, high cholesterol, sleep apnea and more
Morbid obesity: A diagnosis of morbid obesity must have been established for a certain amount of time prior to surgery. This can be up to three years. Your primary care physician will have to submit documentation to that effect. If no documentation has been established, timestamp photographs may be acceptable.
Medical weight loss: Also known as physician supervised weight loss, participation in a medical weight loss program is a likely prerequisite for surgery. This weight loss program may be required in the three or even six months leading up to surgery. During this time, patients will have to prove their participation and the treating physician will submit periodic evaluation to the insurance company.
Smoking: Patients must quit smoking at least two months before surgery.
Overview Of The Nevada Exchange
Since 2015, Nevada Health Link has been a state-run exchange using HealthCare.gov for enrollment. But the exchange began running its own enrollment platform as of the fall of 2019, so Nevada residents now use the Nevada Health Link website to buy coverage in the individual market. After the first month of open enrollment for 2022 coverage, enrollment was trending about 4% higher than last year.
Because Nevada runs its own exchange platform, they were able to offer a special enrollment period in 2020 for uninsured residents in response to the COVID-19 pandemic, during which more than 6,000 people signed up for coverage . Nevada Health Link was also able to extend its open enrollment period for 2021 coverage, due to the flexibility that goes with having a state-run exchange platform. And the exchange also opened a COVID-related enrollment window in 2021.
Lawmakers in Nevada passed a bill in 2017 that would have allowed people in Nevada to buy into the states Medicaid program, but Governor Brian Sandoval vetoed that legislation. As described below, however, legislation was enacted in 2021 that will create a public option program in the state as of 2026.
The Transition From Healthcaregov To A Fully State
In 2014, Nevada ran its own exchange, which was fraught with technological problems. The following year, Nevada switched to using HealthCare.govs enrollment platform, but the kept the rest of the state-run exchange in place, retaining a significant amount of autonomy. That setup remained in place through 2019, but Nevada has now switched back to running its own exchange, including the enrollment platform.
The new system was live as of September 2019, and Nevada residents who were enrolled in 2019 coverage through HealthCare.gov were able to claim their account on Nevada Health Links site.
Enrollment in 2020 health plans in Nevada ended December 15, 2019 . This is the same schedule that HealthCare.gov used for the previous two years, so Nevada residents were already accustomed to the December 15 deadline. But Nevada Health Link opted to extend open enrollment for 2021 plans by a full month, and has now aligned their enrollment schedule with the newly extended schedule that HealthCare.gov is using as of 2022, with enrollment continuing through January 15.
Read Also: How To Obtain Medicaid In Florida
Medicare Plans Offered By Anthem Blue Cross And Blue Shield In Nevada
Learn what Medicare Advantage plans are offered by Anthem Blue Cross and Blue Shield in Nevada. Select a plan below to learn such details as plan premiums, deductibles, and the sort of coverage it provides.
5Medicare Advantage Plans Offered by Anthem Blue Cross and Blue Shield Found in Nevada See Plans
5Medicare Advantage Prescription Drug Plans Offered by Anthem Blue Cross and Blue Shield Found in Nevada See Plans
Northern Nevada Medical Center Is On Most Of The Area’s Health Plans
Northern Nevada Medical Center is a preferred provider for most of the area’s health plans, including the region’s largest commercial insurer, Anthem Blue Cross and Blue Shield network.
The hospital also is a preferred provider for the State of Nevada Public Employees Benefits Program PPO plan, Prominence Health Plan’s HMO networks, Universal Health Network, Nevada Health Partners and many more.
“Most people in the Truckee Meadows can choose our services at preferred rates due to the number of contracted plans in our networks,” said Alan Olive, Northern Nevada Medical Center CEO.
With our practice located in Sparks, its great to have a Blue Cross Blue Shield hospital in Sparks for our patients convenience, said Dr. Jason McKenzie, family practitioner with Family Medicine Associates. More choices, easier access its always good to give patients more options, he added.
Northern Nevadas quality has been recognized with Best Practice rankings in The Gallup Organizations patient satisfaction surveys in outpatient testing and treatment and surgery departments. The hospital has earned The Joint Commission’s Gold Seal of Approval on accreditation of healthcare organizations by demonstrating compliance with the highest national standards for healthcare quality and safety.
Anthem Funds Initiative To Address Nevadas Physician Shortage Support Nevadas Diverse Pre
Anthem Blue Cross and Blue Shield Nevada funding supports the University of Nevada, Reno School of Medicines See It To Be It initiative, which seeks to create a more diverse medical workforce.
RENO, Nev.—-Anthem Blue Cross and Blue Shield Nevadas Medicaid health plan has committed $75,000 to fund a new University of Nevada, Reno School of Medicine initiative called See It To Be It. This initiative will connect aspiring physicians from populations that are underrepresented in medicine and from medically underserved communities with medical students and physicians from similar backgrounds. By supporting pre-med students as they navigate the medical school admissions process, the program will support UNR Med and Anthems shared commitment to preparing a diverse workforce of physicians. In turn, a more diverse medical workforce will be positioned to deliver more equitable healthcare services to multicultural, multiracial and socioeconomically diverse populations as well as to medically underserved communities.
The See It To Be It initiative includes four elements:
About Anthem Blue Cross and Blue Shield Nevada
History Of The Nevada Exchange
Nevadas blueprint for its state-run health insurance exchange received federal approval on Dec. 3, 2012. Gov. Sandoval and the state legislature created the Silver State Health Insurance Exchange in 2011, and the state moved steadily to get the marketplace up and running.
Nevada Health Link operates as a free market facilitator or clearinghouse, meaning it allows all qualified health insurance companies to sell policies on the exchange.
Nevada had contracted with Xerox to build the states exchange platform, but the system never worked correctly .
On May 20, 2014, the exchange board unanimously voted to drop Xerox and switch to Healthcare.gov instead. Xerox had been paid about $12 million of the $72 million that had been allocated to build the exchange, but it was determined that they would only receive a small portion of the remaining funds, since much of the site was never built or was not built correctly. However, Xerox continued to work with Nevada Health Link until April 2015, running call centers and enrolling applicants who qualified for a special open enrollment period during the latter part of 2014.
Things went much better for Nevada Health Link during the second open enrollment period, since they were using Healthcare.gov as their enrollment platform. The state retained some responsibilities and was still legally be classified as a state-run exchange.
Don’t Miss: Does Medicare Or Medicaid Pay For Glasses
Rate Changes In Prior Years
For perspective, heres a look at how average premiums have changed over the years for plans sold in Nevadas exchange :
2015: Average rate increase of 6.4%. The average rate changes ranged from a 6.9% decrease to a 24% increase.
2016: Average rate increase of 9.6%. But Anthems PPO option was new for 2016, and roughly a third of the exchange enrollees had to select coverage from a different carrier for 2016. For the remaining enrollees, the average premium increase within the exchange was 8.7% but thats assuming people didnt shop around to find a better deal.
2017: Average rate increase of 10.6%. This was lower than the 15.02% that the carriers had initially requested. The overall average increase in Nevada ended up significantly lower than the national average of about 25%.
2018: Average rate increase of 36.8%. Two insurers offered plans in Nevadas exchange for 2018. Silver Summit was new to the exchange for 2018, so there was no applicable rate change. Health Plan of Nevada, which was only available in Clark, Nye, and Washoe counties, increased their average premiums by 36.8% that year. Anthem had proposed a 62% average rate increase, but Anthem ultimately ended up withdrawing from the exchange at the end of 2017 .
2020: Average increase of 1.6% in the exchange 1.9% outside the exchange. Three insurers offered plans in Nevadas exchange for 2020: Health Plan of Nevada, SilverSummit, and HMO Colorado . Their average approved rate increase was 1.6%.
Public Option Legislation Enacted In 2021 Plans Will Be Available For 2026
Nevada S.B.420, signed into law in June 2021, calls for the state to create a public option health plan that would be available in the individual market as of 2026, and possibly also in the small group market. Medical providers who contract with the Nevada Medicaid program or the Nevada Public Employees Benefits Program will be required to also contract with the public option, and reimbursement rates will be comparable to or better than the amount that Medicare pays providers.
Stakeholders will meet to work out the details over the coming years, but the public option will include at least one silver-level plan and one gold-level plan that will be available through Nevada Health Link. Premiums for the public option plan will initially be 5% lower than the benchmark plan premium , and the program will target a 15% reduction in premiums over the next four years.
Voxs Dylan Scott interviewed Nevada Senate Majority Leader Nicole Cannizzaro about S.B420 prior to the passage of the bill Cannizzaro explains the goals of the program and why its needed in Nevada. As has been the case with public option bills in other states, however, the idea is certainly not without controversy, and has drawn criticism from health care providers who worry that their reimbursement rates will be lower under the public option program.
You May Like: What’s Better Medicare Or Medicaid
More Nevada Health Insurance Exchange Links
About our health insurance quote forms and phone lines
We do not sell insurance products, but this form will connect you with partners of healthinsurance.org who do sell insurance products. You may submit your information through this form, or callto speak directly with licensed enrollers who will provide advice specific to your situation. Read aboutyour data and privacy.
The mission of healthinsurance.org and its editorial team is to provide information and resources that help American consumers make informed choices about buying and keeping health coverage. We are nationally recognized experts on the Affordable Care Act and state health insurance exchanges/marketplaces.Learn more about us.
If you have questions or comments on this service, pleasecontact us.
Have Your Needs Changed We Are Here For You
Be sure to review your personalized renewal letter packet. It includes plan updates and other specific information. Anthem is here to answer your questions, help you update your coverage, and see if you are eligible for financial help.
Our licensed specialists will review your healthcare needs and give you 1-on-1 guidance to help you find the right Anthem plan for you.
Call us at 225-6272 from 8:00 a.m. to 8:00 p.m., Monday to Friday to talk to a Health Plan Advisor. Or visit MyAnthemAppointment.com to schedule an appointment and we’ll call you back. For faster answers to financial help questions, please have income information available.
You May Like: Tens Unit Covered By Medicaid
The Transition Back To A Fully State
Theres no legislative session in even-numbered years in Nevada, but in February 2018, the Nevada Legislatures Interim Finance Committee approved $1 million in funding for Nevada Health Link to transition back to using its own website for enrollment, rather than HealthCare.gov, starting in the fall of 2019.
On March 19, 2018, Nevada Health Link issued a Request for Proposal, seeking bids from vendors who would create an integrated online health insurance exchange technology platform and associated consumer assistance center, which would be up and running by the fall of 2019, in time for the start of the seventh open enrollment period. The exchange unanimously selected GetInsured as the vendor that would orchestrate the transition to a fully state-based exchange, and manage the call center for the Nevada exchange . The exchange anticipated that the transition would reduce technology operating costs by about 50% from $12 million a year to about $6 million a year.