Connecticut HMO Anthem Blue Cross and Blue Shield To Phase Out Health Plans That Require Specialist Referrals

Officials from Anthem Blue Cross and Blue Shield of Connecticut on Thursday announced that over the next two years, the insurer will phase out "gatekeeper" health plans that require a physician's referral for appointments with specialists because such plans do not save as much money as they used to, the Hartford Courant reports. The "gatekeeper" HMO plans were designed to reduce unnecessary visits to specialists, which often cost more than services provided by primary care physicians. However, Anthem and other HMOs are now finding that there is little difference in claims between "gatekeeper" plans and "open access" plans, which allow members to visit specialists within a network without prior authorization, the Courant reports. "We think that has everything to do with the fact that our members are not seeking specialty care inappropriately," Joan Lane, Anthem's regional program director in product strategy, said. The phase-out, which will be implemented as plans expire, will affect 10% to 15% of the Anthem's Connecticut members (Levick, Hartford Courant, 10/17).