Alaska Out-of-Network Reimbursement Update

As healthcare costs continue to increase, the Alaska Department of Commerce, Community, and Economic Development (DCCED) announced on May 12, 2023, they are proceeding with a comprehensive reform package for healthcare reimbursements. DCCED and the Department of Health (DOH) formulated this approach to improve the affordability of healthcare for all Alaskans.

Part of the reform package included the repeal of the 80th percentile regulation. In response, Premera Blue Cross Blue Shield of Alaska is implementing a new out-of-network reimbursement methodology for dates of service beginning January 1, 2024. Reimbursement for medical services is calculated based on a percentage of Alaska Medicare ranging from 125% to 200%. This includes reimbursement for fully insured and self-funded business.

In circumstances where the Centers of Medicare & Medicaid Services (CMS) doesn’t have a rating schedule, we’ll use an amount that’s no less than the lowest amount we pay for the same or similar service from a comparable provider who has a contract agreement with us.

Premera has the largest network in Alaska with 80% of all providers in-network. In addition to our vast network, the Federal No Surprises Act, protects many of our members from large and unanticipated balance bills such as air ambulance, emergency, and ancillary services at a hospital.

Actual payment is subject to Premera payment policies, the subscriber’s benefits and eligibility at the time of service, and the application of certain industry standard claims adjudication procedures.