Question: Last year we had a Bronze HSA plan with Blue Shield. This year we have a Bronze HSA plan with Anthem. After several claims this year I have noticed that IDENTICAL procedures are being paid differently to providers by Anthem vs. Blue Shield (and not to our benefit). Why would plans which are considered the same metal (i.e., Bronze) pay differing amounts? I thought the only difference between insurers was the providers that accepted the plans? If that is not the case, how would it be possible to find out this information before selecting an insurer?
Answer: Each health insurance carrier negotiates payment rates with their own network providers. That's how Anthem and Blue Shield can pay the same provider different amounts for the same treatment. The contracted rates between carriers and providers are not available to the public, so a consumer cannot know in advance exactly what a carrier will pay the provider for any specific treatment of procedure.