Anthem Reveals OrthoNet Plan to Patients: Let’s Read Between the Lines?

Here is what Anthem said and did not say in their recent letter to patients, dated September 1, 2015, regarding OrthoNet:

Dear Member:

“Lots of us need physical therapy and occupational therapy at some point.” And it’s gotten really expensive for Anthem– about 1-2% of total medical costs. “And it can be a confusing part of your benefit plan.” Good news is, it’s about to get a whole lot more confusing because we just hired a discount network middleman, OrthoNet, to help ration the PT and OT services. “We’ve asked OrthoNet, a separate company, to work with your provider to manage the therapy services you need.” In our infinite wisdom, we chose a group that has a history of burying therapists in paperwork, discouraging PTs from providing the therapy you need, and curtailing the prevention of unnecessary injections, surgeries, and the ingestion of potent opioid medications. We’re sure you’ll agree that OrthoNet knows more about therapy than your treating professional physical therapist.”

“Need therapy?”

“No one likes a surprise bill. So it’s really important to make sure therapy is covered by your benefit plan.” -even though we acknowledge that oftentimes, we kick in less than half of what it actually costs to provide PTs’ services. “OrthoNet will work with your provider to make sure that your therapy is considered medically necessary.” This is a great plan because you just cannot trust your physical therapist’s professional opinion.

Beginning November 1, 2015 here’s what you need to do:

1. “If you think you need therapy, it’s probably a good idea to first visit your doctor or specialist and get a treatment plan.” Heard about direct access? Sorry, we don’t cover it. AB 1000 and PT research has not impacted our policies. We’d rather waste our money by paying above market rate for therapy at a Physician Owned Physical Therapy Practices (POPTS).

2. “Ask your doctor or therapist to send that treatment plan to OrthoNet.” Also, it’s a good idea to get a PT treatment plan from a physician or specialist, even though they are largely not trained to develop a therapy plan, having received only a few hours of training regarding PT in medical school.

3. “Contact Anthem Member Services at the Number on your ID card to be sure that therapy is covered by your plan.” We hope you don’t mind wasting even more of your valuable time verifying that your extremely expensive health insurance fractionally covers a basic need that is so inexpensive & cost-effective.

“We’re letting our in-network doctors and therapists know about these changes too.” -and most of them are pretty infuriated with this update. “If you see at out-of network doctor or therapist, you’ll want to let them know that they need to get this approval from OrthoNet.” This is very important to Anthem because we shell out a whopping $25 for out-of-network physical therapy visits.

Reprinted from Independent Physical Therapists of California

Andrew Vertson

Andrew Vertson

Andrew received his Bachelor’s Degree in Exercise Science from California State University, Fresno in 1991. He then earned his Master’s degree of Physical Therapy in 1996 and his Doctorate degree of Physical Therapy in 2002 from Loma Linda University. In 1996 he also earned his Certification as an Athletic Trainer. He has also completed extensive post-graduate course work in orthopedic manual therapy through Kaiser-West Los Angeles and the Ola Grimsby Institute.
Andrew Vertson

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