The local recently learned that the HPCC provided to members shows Allergy Testing and Treatment as 100% covered and included under the Preventative Care Coverage category. Members were being assessed a $20 co-payment for these services or full responsibility if the allowable amount was less than $20. Of course, during negotiations we agreed to modify the $15 physician's office visit to $20. Setting aside what the HPCC states, these services have been routinely covered at 100% when there is no physician encounter. The physician encounter is determined when a physician's office visit is billed. Treatments have been charged when no Office Visit charge had been submitted, but yet a copayment was deducted as a member responsibility.

Anthem is making the necessary system changes to treat allergy treatments as preventive services unless an office visit is billed which is not preventive. The coding change will be completed by 6/12/2013. Allergy claims have been stopped and will be processed manually until the coding change is complete. Once the change is implemented, Anthem will run a report to identify and reprocess any claims that took the additional co-payment for testing and treatment.