Reimbursement rate for non-participating providers of durable medical equipment to change

Effective January 1, 2020, non-participating providers of durable medical equipment (DME) will be reimbursed at the same rate Anthem has negotiated with participating providers of DME. DME includes items such as wheelchairs, crutches, oxygen supplies, ostomy supplies, etc. This change does not change the network status of these providers.

 

It also does not represent a change to Anthem members’ DME benefit and they can continue to use these out of network (OON) providers for DME services as long as they continue to have OON benefits. However, if you decide to refer an Anthem member to a non-participating DME provider, you will need to comply with our Advance Patient Notice (APN) Policy.  As an Anthem participating provider you are obligated to refer members to Anthem participating providers to ensure a member is maximizing their benefit plan.  If you decide to refer a member to a non-participating provider, you will need to have the member fill out the Non Par Authorization form as provided in the policy.

 

You can help your patients who are Anthem members maximize their benefits by encouraging them to use in-network (INN) DME providers. They can get details about INN DME providers at the Find a Doctor tool on anthem.com or by calling Member Services at the number on the back of their ID card.

 

On or about October 1, we will send a letter to Anthem members who have purchased DME from non-par providers in the last 12 months notifying them about this change and the possible impact to their out-of-pocket responsibility.