In a move that many other health plans made years ago, Anthem says it has been phasing out referral requirements for members to see specialists in most regions of the country.
The Indianapolis-based insurer's latest step is in Connecticut. Last week, the company announced that over the next two years it will shift 140,000 to 210,000 members in that state from gatekeeper HMOs to open-access plans that allow visits to specialists without prior authorization.
Earlier this year, the company eliminated referral requirements to see specialists in Indiana, Ohio and Kentucky, affecting 400,000 members, Anthem spokesperson Deborah New reports.
New adds that Anthem's west region, which serves Colorado and Nevada, has "significantly reduced requirement for referrals for many procedures over time."
She says she has no information about changes in referral requirement for Anthem operations in Virginia.
The Connecticut announcement move comes almost four years after UnitedHealthcare made headlines by announcing it would drop virtually all referral requirements nationwide. In a decision that many saw as a major retreat of managed care, United said savings from the requirements did not justify the costs.
Many plans copied the United policy, but Anthem continued to realize savings from the requirements, says Joan Lane, regional program director in the product strategy area for Anthem in Connecticut.
"In Connecticut, at least, there was some justification for the rate differential, but now we see that it has evaporated," Lane says.