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Office of Program Policy Analysis and Government Accountability

Negative Effects on the State’s Third Party Provider Network from 2009 Law Not Apparent, Report No. 12-01, January 2012
 
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  • Statutory changes made by the 2009 Legislature that require the state group health plan’s third party administrator to directly pay non-network providers for services did not result in a loss of network physicians. Since December 2009, the number of physicians participating in Blue Cross and Blue Shield of Florida’s (BCBS) preferred provider network for the state group has increased by 12.5%. In addition, while the number and amount of non-network physician and other profession claims has increased slightly since 2009, the proportion of these claims to overall physician and other profession claims for the state group has remained at about 2%. Moreover, the discount rate BCBS negotiates with network providers for the state group has remained relatively unchanged.
  • Overall costs for state group health participants have increased; per enrollee per month costs increased from $479 in Fiscal Year 2008-09 to $541 in Fiscal Year 2010-11. However, these increased costs cannot be directly linked to the 2009 law because many factors contribute to rising health care costs.

Which Government Program Summaries contain related information?

Insurance Benefits Administration

    Copies of this report in print or alternate accessible format may be obtained by telephone (850/488-0021), by FAX (850/487-9213), in person, or by mail (OPPAGA Report Production, Claude Pepper Building, Room 312, 111 W. Madison St., Tallahassee, FL 32399-1475).
    e-mail address: oppaga@oppaga.fl.gov


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