Note for Dr. Lee's Anthem Blue Cross Patients

Your insurance company, Anthem Blue Cross, has introduced an arbitrary new point system weighing cost (2 points) equally with quality of care (2 points). As you would expect, such a simplified system does not account for every situation, such as subspecialization within ophthalmology.

My practice is specialized because I almost exclusively see patients referred for cataract or cornea surgery. This makes the cost per patient seem higher than average in terms of cost to the insurance company. However, the insurance company is comparing this cost to the amount spent on general ophthalmologists who primarily perform eye exams and treat non-surgical conditions.

In reality, our practice is in the Anthem Blue Cross network of preferred providers, which means that we have contractually agreed to accept Anthem’s “allowable” PPO rates. The cost of every exam, test, and operation performed on an Anthem patient is contractually set by Anthem Blue Cross. Therefore, what you pay as a patient should be comparable for all in-network ophthalmologists.

We believe we provide extremely high quality and efficient surgical care for our patients and are happy to answer any questions you might have. Thank you for taking the time to look further into Anthem’s point system.

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