As part of the 2017 SEBAC Agreement, some changes were made to healthcare to save money for the State while continuing to provide a high level of care for our members.
What were the changes?
  • Tiered Provider Networks (Preferred Providers) waive the current $15 co-pay for primary care providers and specialists who have been found to provide high quality, cost-effective care.
  • For the Smart Shopper Program, there are currently 9 medical procedures (Colonoscopy, Hip Replacement, Knee Surgery, Spinal Surgery (spinal fusion anterior/posterior), Shoulder Surgery (arthroscopy), Sigmoidoscopy,
    Hysterectomy/Hysteroscopy, and Upper GI) for which rebates will be made available to members based on data showing these procedures are provided in a way that is cost-effective and reduces secondary risks like hospital readmission, hospital-acquired infection, etc.
  • Site of Service is the name for the new network structure for outpatient laboratory services and diagnostic imaging (blood work, urine tests, stool tests, x-rays, MRIs, CT scans, etc.). Plan data has shown tremendous variation in the amount the Plan is charged for outpatient diagnostic tests such as blood tests, MRI, and CAT scans, even though the reading of those results is by the same doctors. To encourage the use of the reasonably priced labs, about 60% of labs and imaging centers will be designated preferred labs and will continue to be 100% covered by the Plan.

 

These changes are starting to be implemented, so below please find links to Preferred Providers, Site of Service, & Smart Shopper for your insurance:
  • Anthem: (there is also a link to a provider lookup tool within this link as well as a listing of all tier 1 providers and preferred site of service facilities)
  • United (Look for a “Preferred”/Tier 1 provider by clicking the Local (Tri-State) Network Provider Search link, and then click on “Find a Physician or Facility.” In your search results, look for 2 full blue hearts.)
  • Site of Service

October 26th, 2017

Posted In: Healthcare, SEBAC

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